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General NPI Number Information
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NPI Number | 1114389996
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Entity Type | Organization
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Legal Business Name | JOHNSON DIAGNOSTIC CENTER INC
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 5917 JOHNSON ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5637
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Country | US
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Telephone | 954-325-1826
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Fax | 954-415-8542
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Provider Business Mailing Address
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Address Line | 5917 JOHNSON ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5637
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Country | US
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Telephone | 954-325-1826
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Fax | 954-415-8542
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS M CANCELL
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Credential | CRT
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Telephone | 954-415-8541
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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 | CRT68355
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License Number State | FL
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