Healthcare Provider Details

I. General information

NPI: 1396711933
Provider Name (Legal Business Name): PALM BEACH RADIOLOGY PROFESSIONALS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N STATE ROAD 7
MARGATE FL
33063-5727
US

IV. Provider business mailing address

DEPT AT 952288
ATLANTA GA
31192-2288
US

V. Phone/Fax

Practice location:
  • Phone: 561-548-3727
  • Fax: 561-548-1238
Mailing address:
  • Phone: 305-503-6320
  • Fax: 305-503-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberME62568
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME62568
License Number StateFL

VIII. Authorized Official

Name: SANTIAGO HERNANDEZ
Title or Position: DIRECTOR
Credential: M.D.
Phone: 561-548-3727