Healthcare Provider Details

I. General information

NPI: 1730115346
Provider Name (Legal Business Name): CORAL WAY MRI & DIAGNOSTICS LLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1757 CORAL WAY
MIAMI FL
33145-2728
US

IV. Provider business mailing address

1757 CORAL WAY
MIAMI FL
33145-2728
US

V. Phone/Fax

Practice location:
  • Phone: 305-460-3114
  • Fax: 305-576-0305
Mailing address:
  • Phone: 305-460-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number127
License Number StateFL

VIII. Authorized Official

Name: MS. JILL M PRESS
Title or Position: MANAGER
Credential:
Phone: 305-460-3114