Healthcare Provider Details

I. General information

NPI: 1295041416
Provider Name (Legal Business Name): PROFESSIONAL MOBILE DIAGNOSTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SW 126TH AVE
MIAMI FL
33175-2129
US

IV. Provider business mailing address

2600 SW 126TH AVE
MIAMI FL
33175-2129
US

V. Phone/Fax

Practice location:
  • Phone: 305-608-6380
  • Fax: 305-662-5965
Mailing address:
  • Phone: 305-608-6380
  • Fax: 305-662-5965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number2471V0105X
License Number StateFL

VIII. Authorized Official

Name: SCOTT BERNSTEIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-608-6380