Healthcare Provider Details

I. General information

NPI: 1508398512
Provider Name (Legal Business Name): TESLA DIAGNOSTICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 GRAND CANAL DR STE 209
MIAMI FL
33144-2575
US

IV. Provider business mailing address

85 GRAND CANAL DR SUITE 209
MIAMI FL
33144-2561
US

V. Phone/Fax

Practice location:
  • Phone: 786-553-8229
  • Fax:
Mailing address:
  • Phone: 786-553-8229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberHCC10976
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberHCC10976
License Number StateFL

VIII. Authorized Official

Name: ANGEL PARGA
Title or Position: OWNER
Credential:
Phone: 786-553-8229