Healthcare Provider Details

I. General information

NPI: 1447237722
Provider Name (Legal Business Name): PRESGAR IMAGING OF CMI NORTH LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 NE MIAMI GARDENS DR
MIAMI FL
33179-5036
US

IV. Provider business mailing address

1860 NE MIAMI GARDENS DR
MIAMI FL
33179-5036
US

V. Phone/Fax

Practice location:
  • Phone: 305-947-1416
  • Fax: 305-947-1569
Mailing address:
  • Phone: 305-947-1416
  • Fax: 305-347-1569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberHCC9937
License Number StateFL

VIII. Authorized Official

Name: MANUEL J VADILLO
Title or Position: DIRECTOR OF OPERATIONS/OWNER
Credential:
Phone: 305-947-1415