Healthcare Provider Details

I. General information

NPI: 1811093131
Provider Name (Legal Business Name): BERNARDINO ORESTES ENRIQUEZ GENERAL RADIOGRAPHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S HOSPITAL DR STE 206 PLANTATION
PLANTATION FL
33317-2837
US

IV. Provider business mailing address

12240 NW 7TH TRL
MIAMI FL
33182-2408
US

V. Phone/Fax

Practice location:
  • Phone: 954-321-3638
  • Fax: 954-321-1422
Mailing address:
  • Phone: 305-505-3619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number38641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: