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General NPI Number Information
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NPI Number | 1407957434
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Entity Type | Organization
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Legal Business Name | AMBULATORY DIAGNOSTIC CENTER INC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 747 PONCE DE LEON BLVD FIRST FLOOR
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City | CORAL GABLES
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State | FL
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Zip | 33134-2049
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Country | US
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Telephone | 305-446-7893
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Fax | 305-442-1183
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Provider Business Mailing Address
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Address Line | 747 PONCE DE LEON BLVD FIRST FLOOR
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City | CORAL GABLES
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State | FL
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Zip | 33134-2049
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Country | US
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Telephone | 305-446-7893
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Fax | 305-442-1183
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILFRED BRACERAS
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Credential |
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Telephone | 305-863-8860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State |
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