Healthcare Provider Details

I. General information

NPI: 1134442205
Provider Name (Legal Business Name): FCID FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 PORT MALABAR BLVD NE SUITE 104
PALM BAY FL
32905-5161
US

IV. Provider business mailing address

709 S HARBOR CITY BLVD SUITE 250
MELBOURNE FL
32901-1938
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-0085
  • Fax:
Mailing address:
  • Phone: 321-750-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DONALD A. BITTAR
Title or Position: SECRETARY
Credential:
Phone: 321-750-0090