=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629148622
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIAGNOSTIC ASSOCIATES OF FLORIDA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1920 E HALLANDALE BEACH BLVD SUITE 901
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-608-5474
-----------------------------------------------------
Fax | 954-385-2838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 268735
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33326-8735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-608-5474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. FERNANDO ANDRES BARBERENA
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 954-608-5474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | HCC4614
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------