Healthcare Provider Details

I. General information

NPI: 1477797553
Provider Name (Legal Business Name): ELITE DIAGNOSTIX, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 N FLAMINGO RD SUITE 166
PEMBROKE PINES FL
33028-3501
US

IV. Provider business mailing address

2114 N FLAMINGO RD SUITE 166
PEMBROKE PINES FL
33028-3501
US

V. Phone/Fax

Practice location:
  • Phone: 954-662-7181
  • Fax:
Mailing address:
  • Phone: 954-662-7181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT AGUILAR
Title or Position: PRESIDENT
Credential:
Phone: 954-662-7181