Healthcare Provider Details

I. General information

NPI: 1417939646
Provider Name (Legal Business Name): FLORIDA MEDICAL DIAGNOSTIC IMAGING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 NE 2ND AVE
MIAMI FL
33137-2706
US

IV. Provider business mailing address

PO BOX 821103
SOUTH FLORIDA FL
33082-1103
US

V. Phone/Fax

Practice location:
  • Phone: 954-450-1885
  • Fax: 954-430-0214
Mailing address:
  • Phone: 954-450-1885
  • Fax: 954-430-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FERNANDO PINZON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 954-450-1885