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General NPI Number Information
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NPI Number | 1548668908
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Entity Type | Organization
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Legal Business Name | MD DIAGNOSTIC SERVICES LLC
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 7405 SW 148TH CT
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City | MIAMI
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State | FL
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Zip | 33193-1144
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Country | US
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Telephone | 786-285-9502
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Fax |
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Provider Business Mailing Address
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Address Line | 7405 SW 148TH CT
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City | MIAMI
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State | FL
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Zip | 33193-1144
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Country | US
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Telephone | 786-285-9502
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/TECHNICIAN
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Name | MS. ELESDANIA MALDONADO SANZ
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Credential |
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Telephone | 786-285-9502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | 147114
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License Number State | FL
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