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General NPI Number Information
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NPI Number | 1679371637
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Entity Type | Organization
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Legal Business Name | SANITAS LAUDERDALE LAKES IDTC
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 4850 W OAKLAND PARK BLVD STE 136
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-7277
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Country | US
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Telephone | 954-945-3530
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Fax |
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Provider Business Mailing Address
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Address Line | 8400 NW 33RD ST STE 201
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City | DORAL
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State | FL
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Zip | 33122-1937
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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 | CFO
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Name | MAYRA G TORRES
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Credential |
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Telephone | 718-918-2370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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