Healthcare Provider Details

I. General information

NPI: 1306937214
Provider Name (Legal Business Name): AB DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 NW 125 ST
OPA LOCKA FL
33054
US

IV. Provider business mailing address

3803 NW 125 ST
OPA LOCKA FL
33054
US

V. Phone/Fax

Practice location:
  • Phone: 305-687-8780
  • Fax: 305-687-8896
Mailing address:
  • Phone: 305-687-8780
  • Fax: 305-687-8896

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 Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LUIS ACOSTA
Title or Position: OWNER
Credential:
Phone: 305-687-8780