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General NPI Number Information
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NPI Number | 1821259169
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Entity Type | Organization
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Legal Business Name | VIVAX-RAY MEDICAL DIAGNOSTIC CENTER, INC
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 3750 W 16TH AVE STE 204
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City | HIALEAH
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State | FL
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Zip | 33012-4648
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Country | US
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Telephone | 305-825-1418
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Fax | 305-825-1419
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Provider Business Mailing Address
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Address Line | 3750 W 16TH AVE STE 136U
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City | HIALEAH
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State | FL
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Zip | 33012-4654
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Country | US
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Telephone | 305-825-1418
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Fax | 305-825-1419
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Authorized Official
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Title or Position | PRESIDENT
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Name | OSMIN VIVAS
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Credential | R.T(R)
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Telephone | 305-825-1418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | HCC7919
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License Number State | FL
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