Healthcare Provider Details

I. General information

NPI: 1427051887
Provider Name (Legal Business Name): FLORIDA DIAGNOSTIC PORTABLE IMAGING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 BABCOCK ST NE STE 2
PALM BAY FL
32905-4637
US

IV. Provider business mailing address

5201 BABCOCK ST NE STE 2
PALM BAY FL
32905-4637
US

V. Phone/Fax

Practice location:
  • Phone: 321-984-8001
  • Fax: 321-728-0523
Mailing address:
  • Phone: 321-984-8001
  • Fax: 321-728-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. BRUCE D COTTI
Title or Position: OWNER
Credential: R.T.(R)
Phone: 321-984-8001