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General NPI Number Information
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NPI Number | 1588111488
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Entity Type | Organization
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Legal Business Name | LIFE RADIOLOGY LLC
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Dates
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Enumeration Date | 09/08/2016
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 3470 NW 82ND AVE SUITE 119
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City | DORAL
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State | FL
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Zip | 33122-1024
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Country | US
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Telephone | 786-446-8541
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Fax | 786-446-8542
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Provider Business Mailing Address
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Address Line | 5901 SW 114TH TER
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City | PINECREST
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State | FL
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Zip | 33156-5030
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Country | US
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Telephone | 786-446-8541
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Fax | 786-446-8542
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Authorized Official
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Title or Position | MGR
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Name | ALEX ALONSO
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Credential | M.D
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Telephone | 786-446-8541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number | ME84005
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | ME84005
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | ME84005
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License Number State | FL
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