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General NPI Number Information
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NPI Number | 1700269784
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Entity Type | Organization
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Legal Business Name | IMAGING NATION DIAGNOSTICS CORP
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Dates
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Enumeration Date | 07/08/2015
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 1250 SW 27TH AVE STE 303
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City | MIAMI
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State | FL
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Zip | 33135-4749
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Country | US
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Telephone | 786-353-9160
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Fax | 786-580-3174
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Provider Business Mailing Address
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Address Line | 1250 SW 27TH AVE STE 303 303
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City | MIAMI
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State | FL
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Zip | 33135-4749
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Country | US
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Telephone | 786-353-9160
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Fax | 786-580-3174
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICARDO ALFONSO
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Credential |
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Telephone | 786-353-9160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | HCC10377
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License Number State | FL
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