Healthcare Provider Details

I. General information

NPI: 1801810494
Provider Name (Legal Business Name): CARDIOVASCULAR DIAGNOSTIC IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10621 N KENDALL DR SUITE 101
MIAMI FL
33176-1530
US

IV. Provider business mailing address

10621 N KENDALL DR SUITE 101
MIAMI FL
33176-1530
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-4136
  • Fax: 305-596-0668
Mailing address:
  • Phone: 305-595-4136
  • Fax: 305-596-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateFL

VIII. Authorized Official

Name: EDELIO MIRABOLO
Title or Position: PRESIDENT
Credential:
Phone: 305-595-4136