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General NPI Number Information
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NPI Number | 1780015297
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH'S DIAGNOSTIC CENTER, LLC.
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 2222 W SWANN AVE
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City | TAMPA
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State | FL
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Zip | 33606-2426
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Country | US
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Telephone | 813-554-8176
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 403800
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City | ATLANTA
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State | GA
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Zip | 30384-3800
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Country | US
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Telephone | 813-852-3272
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TAMBLYN CUBERO
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Credential |
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Telephone | 727-281-9390
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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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