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General NPI Number Information
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NPI Number | 1093769531
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Entity Type | Organization
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Legal Business Name | U.S. MOBILE DIAGNOSTIC, LLC
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 3907 N FEDERAL HWY SUITE 112
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City | POMPANO BEACH
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State | FL
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Zip | 33064-6042
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Country | US
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Telephone | 954-461-8624
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Fax | 954-596-8132
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Provider Business Mailing Address
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Address Line | 3907 N FEDERAL HWY SUITE 112
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City | POMPANO BEACH
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State | FL
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Zip | 33064-6042
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Country | US
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Telephone | 954-461-8624
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Fax | 954-596-8132
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Authorized Official
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Title or Position | CO-OWNER/MEDICAL DIRECTOR
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Name | DR. JEFFREY JOHN TRANTALIS
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Credential | D.P.M.
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Telephone | 954-461-8624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | HCC6512
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License Number State | FL
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