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General NPI Number Information
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NPI Number | 1043732308
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Entity Type | Organization
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Legal Business Name | IC SONOGRAPHY INC
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8401 NW 8TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6633
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Country | US
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Telephone | 786-374-5110
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Fax | 954-212-0114
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Provider Business Mailing Address
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Address Line | 8401 NW 8TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6633
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Country | US
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Telephone | 786-374-5110
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Fax | 954-212-0114
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Authorized Official
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Title or Position | ULTRASOUND TECH
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Name | LARITZA LUGO
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Credential |
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Telephone | 786-374-5110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | 149090
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License Number State | FL
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