Healthcare Provider Details

I. General information

NPI: 1104164540
Provider Name (Legal Business Name): JENPI DIAGNOSTIC CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 NE 40TH RD
HOMESTEAD FL
33033-5929
US

IV. Provider business mailing address

1041 NE 40TH RD
HOMESTEAD FL
33033-5929
US

V. Phone/Fax

Practice location:
  • Phone: 305-396-3298
  • Fax: 786-999-6425
Mailing address:
  • Phone: 305-396-3298
  • Fax: 786-999-6425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License NumberME81181
License Number StateFL

VIII. Authorized Official

Name: PABLO OROZCO
Title or Position: OWNER
Credential:
Phone: 305-396-3298