=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518910488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSET RADIOLOGY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 03/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7000 SW 97TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-1494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-273-6602
-----------------------------------------------------
Fax | 305-273-6603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7000 SW 97TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-1474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-273-6602
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CARLOS A RAVENTOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-273-6602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number | HCC 4307
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------