Healthcare Provider Details

I. General information

NPI: 1326202920
Provider Name (Legal Business Name): FLORIDA IMAGING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2008
Last Update Date: 07/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 RED BUG LAKE RD SUITE 1020
OVIEDO FL
32765-9290
US

IV. Provider business mailing address

7250 RED BUG LAKE RD SUITE 1020
OVIEDO FL
32765-9290
US

V. Phone/Fax

Practice location:
  • Phone: 407-706-1770
  • Fax: 407-706-1777
Mailing address:
  • Phone: 407-706-1770
  • Fax: 407-706-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number105264
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number105264
License Number StateOH

VIII. Authorized Official

Name: VITALY BLATNOY
Title or Position: MANAGER
Credential: MD
Phone: 407-706-1770