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General NPI Number Information
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NPI Number | 1356331326
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Entity Type | Organization
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Legal Business Name | MEDICAL DIAGNOSTIC CENTER OF JACKSONVILLE
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3550 UNIVERSITY BLVD S STE 102
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4246
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Country | US
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Telephone | 904-731-7296
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Fax | 904-636-9875
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Provider Business Mailing Address
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Address Line | 3550 UNIVERSITY BLVD S STE 102
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4246
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Country | US
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Telephone | 904-731-7296
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Fax | 904-636-9875
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Authorized Official
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Title or Position | BUSINESS DIRECTOR
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Name | MR. NICOLAU SACAQUINI
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Credential |
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Telephone | 904-731-1556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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