Healthcare Provider Details

I. General information

NPI: 1598987216
Provider Name (Legal Business Name): MOBILE X PRESS RAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9995 SW 72ND ST STE 202
MIAMI FL
33173-4662
US

IV. Provider business mailing address

9995 SW 72ND ST STE 202
MIAMI FL
33173-4662
US

V. Phone/Fax

Practice location:
  • Phone: 786-457-7784
  • Fax: 305-280-4129
Mailing address:
  • Phone: 305-457-7784
  • Fax: 305-280-4129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberHCC 9124
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberMM30779
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License NumberJR4260900
License Number StateFL

VIII. Authorized Official

Name: MRS. REGLA D. TRUJILLO
Title or Position: P
Credential: REGLA D. TRUJILLO
Phone: 305-457-7784