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General NPI Number Information
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NPI Number | 1114247053
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Entity Type | Organization
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Legal Business Name | CLEVELAND RADIOLOGY CENTER INC
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 12995 S CLEVELAND AVE STE 182
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City | FORT MYERS
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State | FL
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Zip | 33907-7719
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Country | US
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Telephone | 305-775-9986
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Fax |
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Provider Business Mailing Address
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Address Line | 12995 S CLEVELAND AVE STE 182
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City | FORT MYERS
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State | FL
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Zip | 33907-7719
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Country | US
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Telephone | 305-775-9986
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. MARIO FONSECA
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Credential |
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Telephone | 305-775-9986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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