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General NPI Number Information
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NPI Number | 1790973063
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Entity Type | Organization
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Legal Business Name | CANCER SERVICES OF AVENTURA LLC
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 20950 NE 27TH CT
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City | AVENTURA
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State | FL
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Zip | 33180-1232
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Country | US
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Telephone | 305-682-2151
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Fax | 305-792-5851
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Provider Business Mailing Address
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Address Line | 20950 NORTH EAST 27TH COURT
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City | AVENTURA
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State | FL
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Zip | 33180
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Country | US
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Telephone | 305-682-2151
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Fax | 305-792-5851
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Authorized Official
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Title or Position | REGIONAL DIRECTOR
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Name | JOAN R GLADNEY
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Credential |
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Telephone | 352-474-6190
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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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