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General NPI Number Information
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NPI Number | 1275664336
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Entity Type | Organization
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Legal Business Name | CALIFORNIA CLUB DIAGNOSTIC CENTER, LLC.
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 850 IVES DAIRY RD SUITE # 14
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33179-2450
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Country | US
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Telephone | 305-405-0365
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Fax | 305-405-0370
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Provider Business Mailing Address
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Address Line | 850 IVES DAIRY RD SUITE # 14
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33179-2450
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Country | US
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Telephone | 305-405-0365
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Fax | 305-405-0370
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Authorized Official
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Title or Position | MANAGER
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Name | ALEXANDER BARANOV
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Credential |
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Telephone | 305-405-0365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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