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General NPI Number Information
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NPI Number | 1184709701
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HEALTH DIAGNOSTICS, INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 6527 SW 24TH ST
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City | MIAMI
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State | FL
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Zip | 33155-1843
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Country | US
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Telephone | 305-441-2262
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Fax | 305-441-2292
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Provider Business Mailing Address
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Address Line | 6527 SW 24TH ST
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City | MIAMI
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State | FL
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Zip | 33155-1843
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Country | US
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Telephone | 305-441-2262
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Fax | 305-441-2292
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Authorized Official
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Title or Position | DIRECTOR/OFFICER
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Name | ANA C GOENAGA
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Credential |
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Telephone | 305-441-2262
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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 | CC5108
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License Number State | FL
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