Healthcare Provider Details

I. General information

NPI: 1275590192
Provider Name (Legal Business Name): HEART STUDY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W STATE ROAD 434 SUITE A
LONGWOOD FL
32750-5156
US

IV. Provider business mailing address

755 W STATE ROAD 434 SUITE A
LONGWOOD FL
32750-5156
US

V. Phone/Fax

Practice location:
  • Phone: 407-834-1151
  • Fax: 407-834-2232
Mailing address:
  • Phone: 407-834-1151
  • Fax: 407-834-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License NumberP97000031620
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License NumberP97000031620
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberP97000031620
License Number StateFL

VIII. Authorized Official

Name: MRS. BLANCA M RODRIGUEZ
Title or Position: GENERAL MANAGER
Credential:
Phone: 407-834-1151