Healthcare Provider Details

I. General information

NPI: 1922637867
Provider Name (Legal Business Name): UNIVERSAL MEDICAL DIAGNOSTIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 BLUE LAGOON DR STE 400
MIAMI FL
33126-6040
US

IV. Provider business mailing address

133 E 14TH ST
HIALEAH FL
33010-3543
US

V. Phone/Fax

Practice location:
  • Phone: 877-553-3319
  • Fax:
Mailing address:
  • Phone: 786-267-7659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QG0250X
TaxonomyGenetics Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JOSE RAUL RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-267-7659