=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831323971
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCE IMAGING CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2009
-----------------------------------------------------
Last Update Date | 09/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3320 PALM AVE
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-5241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-863-1755
-----------------------------------------------------
Fax | 305-863-1756
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3320 PALM AVE
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-5241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-863-1755
-----------------------------------------------------
Fax | 305-863-1756
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROGELIO A CATTAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-863-1755
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number | HCC7513
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------