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NPI Code Detail

MEDICARE: MOBILE QUALITY DIAGNOSTIC CORP

MEDICARE: MOBILE QUALITY DIAGNOSTIC CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1335V00000XPortable X-ray and/or Other Portable Diagnostic Imaging SupplierHCC4270FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104819648
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOBILE QUALITY DIAGNOSTIC CORP
Provider Business Mailing Address
First Line : 1751 W 38TH PL
Second Line : UNIT 1003-A
City : HIALEAH
State : FL
Zip : 33012-7021
Country : US
Telephone Number : 305-820-8720
Fax Number : 305-820-8721
Provider Business Practice Location Address
First Line : 1751 W 38TH PL
Second Line : #1003-A
City : HIALEAH
State : FL
Zip : 33012-7021
Country : US
Telephone Number : 305-820-8720
Fax Number : 305-820-8721
Authorized Official
Title or Position : PRESIDENT
Name : MR. REYNALDO ORTEGA
Credential : RT RVS
Telephone Number : 305-820-8720
Provider Enumeration Date : 08/30/2005
Last Update Date : 04/12/2011

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Practice Location Address:
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Directions to “MOBILE QUALITY DIAGNOSTIC CORP ” Practice Location

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