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General NPI Number Information
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NPI Number | 1407840937
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC PORTABLE LAB
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 21110 BISCAYNE BLVD STE 206
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City | AVENTURA
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State | FL
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Zip | 33180-1227
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Country | US
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Telephone | 301-931-7884
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Fax | 305-933-3203
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Provider Business Mailing Address
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Address Line | 21110 BISCAYNE BLVD STE 206
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City | AVENTURA
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State | FL
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Zip | 33180-1227
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Country | US
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Telephone | 301-931-7884
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Fax | 305-933-3203
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ENRIQUE HANABERGH
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Credential | MD
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Telephone | 305-931-7884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246XC2903X
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Taxonomy Name | Vascular Specialist/Technologist Cardiovascular
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246XS1301X
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Taxonomy Name | Sonography Specialist/Technologist Cardiovascular
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License Number |
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License Number State |
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