=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477696524
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCURAD MOBILE DIAGNOSTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2640 NE 135TH STREET SUITE 403
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-483-7346
-----------------------------------------------------
Fax | 305-945-9257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2640 NE 135TH STREET SUITE 403
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-483-7346
-----------------------------------------------------
Fax | 305-945-9257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER OWNER
-----------------------------------------------------
Name | MR. EDWARD L CARIAGA
-----------------------------------------------------
Credential | RTR RADIOLOGY TECHNO
-----------------------------------------------------
Telephone | 954-483-7346
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number | JR4219400
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------