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General NPI Number Information
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NPI Number | 1902214091
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Entity Type | Organization
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Legal Business Name | FLORIDA DIAGNOSTICS SERVICES INC
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Dates
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Enumeration Date | 08/01/2014
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Last Update Date | 08/01/2014
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Provider Practice Location Address
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Address Line | 10621 N KENDALL DR STE 101A
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City | MIAMI
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State | FL
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Zip | 33176-1549
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Country | US
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Telephone | 305-915-4134
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Fax | 786-360-4724
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Provider Business Mailing Address
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Address Line | 106210 N.KENDAL DR SUITE 101A
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City | MIAMI
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State | FL
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Zip | 33176
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Country | US
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Telephone | 305-915-4134
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Fax | 786-360-4724
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS A MACHADO
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Credential |
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Telephone | 305-915-4134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | MA69369
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License Number State | FL
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