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General NPI Number Information
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NPI Number | 1972632321
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Entity Type | Organization
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Legal Business Name | MEDICUS DIAGNOSTICS INC
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Dates
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Enumeration Date | 03/03/2007
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 9980 CENTRAL PARK BLVD N SUITE 116
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City | BOCA RATON
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State | FL
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Zip | 33428-1762
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Country | US
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Telephone | 561-893-0651
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Fax | 561-893-0655
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Provider Business Mailing Address
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Address Line | 9980 CENTRAL PARK BLVD N SUITE 116
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City | BOCA RATON
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State | FL
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Zip | 33428-1762
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Country | US
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Telephone | 561-893-0651
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Fax | 561-893-0655
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FERNANDO M LOPEZ-IVERN
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Credential | M.D.
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Telephone | 561-893-0651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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