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General NPI Number Information
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NPI Number | 1134375686
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Entity Type | Organization
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Legal Business Name | STAR DIAGNOSTIC TREATMENT AND AMBULATARY SERVICES
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Dates
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Enumeration Date | 08/15/2008
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Last Update Date | 08/15/2008
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Provider Practice Location Address
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Address Line | 1840 W 49ST 311 B
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City | HIALEAH
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State | FL
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Zip | 33012
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Country | US
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Telephone | 305-818-0600
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Fax | 305-818-0620
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Provider Business Mailing Address
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Address Line | 1840 W 49TH ST 311 B
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City | HIALEAH
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State | FL
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Zip | 33012-2942
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Country | US
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Telephone | 305-818-0600
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Fax | 305-818-0062
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. GERALD AMADO
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Credential | M.D
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Telephone | 305-818-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC5605
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License Number State | FL
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