Healthcare Provider Details

I. General information

NPI: 1437831294
Provider Name (Legal Business Name): AURORA BREAST IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6548
US

IV. Provider business mailing address

4835 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6548
US

V. Phone/Fax

Practice location:
  • Phone: 954-908-1277
  • Fax: 954-908-1278
Mailing address:
  • Phone: 954-908-1277
  • Fax: 954-908-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AURORA LUNA
Title or Position: OWNER
Credential: MD
Phone: 713-703-5255