Healthcare Provider Details

I. General information

NPI: 1407221096
Provider Name (Legal Business Name): TOTAL DIAGNOSTIC SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 NW 40TH AVE # 2A
LAUDERHILL FL
33313-5801
US

IV. Provider business mailing address

297 SW 27TH AVE
MIAMI FL
33135-1401
US

V. Phone/Fax

Practice location:
  • Phone: 954-634-3326
  • Fax: 954-617-8954
Mailing address:
  • Phone: 305-960-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberHCC10204
License Number StateFL

VIII. Authorized Official

Name: CARLOS GARCIA
Title or Position: MGRM
Credential:
Phone: 305-960-7050