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General NPI Number Information
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NPI Number | 1932485901
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Entity Type | Organization
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Legal Business Name | MIRIAM DIAGNOSTIC AND SERVICE INC
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Dates
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Enumeration Date | 10/22/2011
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Last Update Date | 03/15/2012
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Provider Practice Location Address
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Address Line | 7822 SW 128TH PL
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City | MIAMI
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State | FL
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Zip | 33183-4275
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Country | US
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Telephone | 786-328-5203
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Fax | 305-433-4090
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Provider Business Mailing Address
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Address Line | 7822 SW 128TH PL
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City | MIAMI
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State | FL
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Zip | 33183-4275
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Country | US
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Telephone | 786-328-5203
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Fax | 305-433-4090
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MIRIAM C REYES
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Credential |
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Telephone | 786-328-5203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | HCC9257
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License Number State | FL
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