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General NPI Number Information
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NPI Number | 1538263033
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Entity Type | Organization
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Legal Business Name | OPEN MRI & DIAGNOSTIC IMAGING, INC.
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16401 NW 2ND AVE SUITE 103
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33169-6036
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Country | US
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Telephone | 305-354-7008
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Fax | 305-354-7091
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Provider Business Mailing Address
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Address Line | 16401 NW 2ND AVE SUITE 103
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33169-6036
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Country | US
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Telephone | 305-354-7008
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Fax | 305-354-7091
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORENZO S BONGOLAN
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Credential | M.D.
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Telephone | 305-354-7008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | HCCR1337
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License Number State | FL
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