MEDICARE: BREAST & ULTRASOUND DIAGNOSTIC SERVICES, INC.

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
1	2085R0202X	Diagnostic Radiology Physician	HCC4409	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	257947	OTHER	FL	AVMED
2	170998	OTHER	FL	WELLCARE STAYWELL
3	77793	OTHER	FL	BCBS
4	216622	OTHER	FL	AMERIGROUP
5	77793	OTHER	FL	ALL OTHERS

General Provider Information

NPI Number	:	1225192263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAST & ULTRASOUND DIAGNOSTIC SERVICES, INC.

Provider Business Mailing Address
First Line	:	4980 W 10TH AVE
Second Line	:	SUITE 102
City	:	HIALEAH
State	:	FL
Zip	:	33012-3437
Country	:	US
Telephone Number	:	305-558-4140
Fax Number	:	305-558-9698

Provider Business Practice Location Address
First Line	:	4980 W 10TH AVE
Second Line	:	SUITE 102
City	:	HIALEAH
State	:	FL
Zip	:	33012-3437
Country	:	US
Telephone Number	:	305-558-4140
Fax Number	:	305-558-9698

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CARLOS EXPOSITO
Credential	:
Telephone Number	:	305-558-4140

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	08/22/2020

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Directions to “BREAST & ULTRASOUND DIAGNOSTIC SERVICES, INC. ” Practice Location

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