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General NPI Number Information
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NPI Number | 1043635600
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Entity Type | Organization
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Legal Business Name | ADVANCE MEDICAL IMAGING AND INTERVENTIONAL ENDOVASCULAR THERAPY
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 2387 W 68TH ST STE 503
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City | HIALEAH
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State | FL
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Zip | 33016-6890
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Country | US
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Telephone | 305-558-0720
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Fax |
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Provider Business Mailing Address
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Address Line | 2387 W 68TH ST STE 503
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City | HIALEAH
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State | FL
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Zip | 33016-6890
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HILARIO MARTINEZ
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Credential |
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Telephone | 845-705-8983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | ME97951
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License Number State | FL
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