Healthcare Provider Details

I. General information

NPI: 1770922445
Provider Name (Legal Business Name): PAVI DIAGNOSTIC CENTER, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FONTAINEBLEAU BLVD SUITE 2J1
MIAMI FL
33172-7018
US

IV. Provider business mailing address

175 FONTAINEBLEAU BLVD SUITE 2J1
MIAMI FL
33172-7018
US

V. Phone/Fax

Practice location:
  • Phone: 786-332-3913
  • Fax: 786-332-2835
Mailing address:
  • Phone: 786-332-3913
  • Fax: 786-332-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License NumberME81181
License Number StateFL

VIII. Authorized Official

Name: JUAN VILLALONGA
Title or Position: PRESIDENT
Credential:
Phone: 786-332-3913