Healthcare Provider Details

I. General information

NPI: 1437478260
Provider Name (Legal Business Name): ENLIGHTEN RADIOLOGY OF FLORIDA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 SW 87TH AVE SUITE 120A
MIAMI FL
33173-5458
US

IV. Provider business mailing address

1751 3RD ST SUITE 102
NORCO CA
92860-2670
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-4425
  • Fax: 305-595-1355
Mailing address:
  • Phone: 415-750-4916
  • Fax: 415-459-4916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME84280
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME72100
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME72100
License Number StateFL

VIII. Authorized Official

Name: MICHAEL A TAYLOR
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 415-750-4916