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General NPI Number Information
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NPI Number | 1629159371
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Entity Type | Organization
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Legal Business Name | CORAL WAY DIAGNOSTIC & MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1333 CORAL WAY
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City | MIAMI
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State | FL
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Zip | 33145-2948
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Country | US
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Telephone | 305-858-8988
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Fax | 305-541-6077
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Provider Business Mailing Address
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Address Line | PO BOX 450676
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City | MIAMI
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State | FL
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Zip | 33245-0676
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Country | US
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Telephone | 305-858-8988
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Fax |
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Authorized Official
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Title or Position | MANAGER LLC
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Name | DEAN M YOUNG
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Credential |
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Telephone | 305-858-8988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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