Healthcare Provider Details

I. General information

NPI: 1972535748
Provider Name (Legal Business Name): PROSONIC MOBILE DIAGNOSTIC CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FOUNTAINBLEAU BLVD STE 165
MIAMI FL
33172-7018
US

IV. Provider business mailing address

175 FOUNTAINBLEAU BLVD STE 165
MIAMI FL
33172-7018
US

V. Phone/Fax

Practice location:
  • Phone: 305-303-5778
  • Fax:
Mailing address:
  • Phone: 305-303-5778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberHCC6320
License Number StateFL

VIII. Authorized Official

Name: PABLO OROZCO
Title or Position: PRESIDENT
Credential:
Phone: 305-303-5778