Healthcare Provider Details

I. General information

NPI: 1154548741
Provider Name (Legal Business Name): JMV DIAGNOSTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15422 SW 115TH ST
MIAMI FL
33196-6310
US

IV. Provider business mailing address

8890 SW 24TH ST SUITE 208
MIAMI FL
33165-2060
US

V. Phone/Fax

Practice location:
  • Phone: 305-992-8857
  • Fax: 305-383-1593
Mailing address:
  • Phone: 305-992-8857
  • Fax: 305-383-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number545566-2
License Number StateFL

VIII. Authorized Official

Name: JAIRO IVAN MENESES
Title or Position: PRESIDENT
Credential:
Phone: 305-992-8857