Healthcare Provider Details

I. General information

NPI: 1730583675
Provider Name (Legal Business Name): STEPHANIE PRESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 N UNIVERSITY DR STE A
PEMBROKE PINES FL
33024-3603
US

IV. Provider business mailing address

2221 N UNIVERSITY DR STE A
PEMBROKE PINES FL
33024-3603
US

V. Phone/Fax

Practice location:
  • Phone: 954-985-6490
  • Fax: 954-985-6491
Mailing address:
  • Phone: 954-985-6490
  • Fax: 954-985-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: