=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346290061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDNOR DIAGNOSTIC CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 05/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2140 W FLAGLER ST STE 201
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33135-1663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-541-0202
-----------------------------------------------------
Fax | 305-541-0599
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2140 W FLAGLER ST STE 201
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33135-1663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-541-0202
-----------------------------------------------------
Fax | 305-541-0599
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. NORMA CRUZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-262-6540
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 247100000X
-----------------------------------------------------
Taxonomy Name | Radiologic Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2471C3402X
-----------------------------------------------------
Taxonomy Name | Radiography Radiologic Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2471S1302X
-----------------------------------------------------
Taxonomy Name | Sonography Radiologic Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2471V0105X
-----------------------------------------------------
Taxonomy Name | Vascular Sonography Radiologic Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 246W00000X
-----------------------------------------------------
Taxonomy Name | Cardiology Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 2471C1101X
-----------------------------------------------------
Taxonomy Name | Cardiovascular-Interventional Technology Radiologic Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------