Healthcare Provider Details

I. General information

NPI: 1174022958
Provider Name (Legal Business Name): MRI RADIOLOGY NETWORK PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E SAMPLE RD STE 100
POMPANO BEACH FL
33064-3552
US

IV. Provider business mailing address

3848 FAU BLVD STE 200
BOCA RATON FL
33431-6437
US

V. Phone/Fax

Practice location:
  • Phone: 561-362-9191
  • Fax: 561-394-5674
Mailing address:
  • Phone: 561-826-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberME56655
License Number StateFL

VIII. Authorized Official

Name: THERESE LEONZAL
Title or Position: V.P.
Credential:
Phone: 561-826-1202