Healthcare Provider Details

I. General information

NPI: 1780566893
Provider Name (Legal Business Name): MILLENNIUM DIAGNOSTIC IMAGING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 SW 24TH ST STE 100
MIAMI FL
33165-2075
US

IV. Provider business mailing address

8900 SW 24TH ST STE 100
MIAMI FL
33165-2075
US

V. Phone/Fax

Practice location:
  • Phone: 305-229-9511
  • Fax: 305-229-9112
Mailing address:
  • Phone: 305-229-9511
  • Fax: 305-229-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IVETTE DIAZ
Title or Position: PRESIDENT
Credential:
Phone: 305-229-9115