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General NPI Number Information
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NPI Number | 1437572658
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Entity Type | Organization
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Legal Business Name | LYRON DIAGNOSTIC CENTER CORP
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 19100 SW 177TH AVE STE 3
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City | MIAMI
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State | FL
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Zip | 33187-2021
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Country | US
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Telephone | 305-964-7618
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Fax | 786-732-0473
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Provider Business Mailing Address
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Address Line | 19100 SW 177TH AVE STE 3
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City | MIAMI
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State | FL
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Zip | 33187-2021
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Country | US
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Telephone | 305-964-7618
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Fax | 786-732-0473
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Authorized Official
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Title or Position | PRESIDENT
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Name | LIRON BELTZER
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Credential | MD
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Telephone | 305-964-7618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ME105585
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License Number State | FL
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