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General NPI Number Information
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NPI Number | 1811024680
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Entity Type | Organization
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Legal Business Name | SOUTHERN DIAGNOSTIC INC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 5941 NW 173RD DR SUITE 2
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City | HIALEAH
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State | FL
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Zip | 33015-5109
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Country | US
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Telephone | 305-642-7767
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Fax |
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Provider Business Mailing Address
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Address Line | 5941 NW 173RD DR SUITE 2
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City | HIALEAH
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State | FL
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Zip | 33015-5109
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Country | US
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Telephone | 305-642-7767
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FRANCISCO LOPEZ
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Credential |
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Telephone | 305-642-7767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number |
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License Number State |
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