Healthcare Provider Details

I. General information

NPI: 1649252578
Provider Name (Legal Business Name): DIGITAL MEDICAL DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 TAMIAMI CANAL RD
MIAMI FL
33144-2538
US

IV. Provider business mailing address

41 TAMIAMI CANAL RD
MIAMI FL
33144-2538
US

V. Phone/Fax

Practice location:
  • Phone: 786-367-3554
  • Fax: 305-269-0851
Mailing address:
  • Phone: 786-367-3554
  • Fax: 305-269-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. ISABEL C. CHAVIANO
Title or Position: PRESIDENT
Credential:
Phone: 786-367-3554