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General NPI Number Information
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NPI Number | 1639110042
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Entity Type | Organization
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Legal Business Name | L G DIAGNOSTIC INC
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 689 E 9TH ST
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City | HIALEAH
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State | FL
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Zip | 33010-4523
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Country | US
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Telephone | 305-884-3233
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Fax |
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Provider Business Mailing Address
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Address Line | 689 E 9TH ST
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City | HIALEAH
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State | FL
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Zip | 33010-4523
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDUARDO GUERRA
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Credential |
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Telephone | 305-884-3233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number | HCC4353
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License Number State | FL
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