Healthcare Provider Details

I. General information

NPI: 1164415055
Provider Name (Legal Business Name): MP DIAGNOSTIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9090 SW 87TH CT
MIAMI FL
33176-2305
US

IV. Provider business mailing address

PO BOX 160608
MIAMI FL
33116-0608
US

V. Phone/Fax

Practice location:
  • Phone: 305-279-7275
  • Fax: 305-675-3627
Mailing address:
  • Phone: 305-279-7275
  • Fax: 786-219-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: ALVARO GARCIA VILLEGAS
Title or Position: CEO
Credential:
Phone: 305-279-7275