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NPI Code Detail

MEDICARE: DIAGNOSTIC PORTABLE LAB

MEDICARE: DIAGNOSTIC PORTABLE LAB
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
1246XC2903XVascular Specialist/Technologist Cardiovascular
2246XS1301XSonography Specialist/Technologist Cardiovascular

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1V1034OTHERFLBCBS

General Provider Information

NPI Number : 1407840937
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIAGNOSTIC PORTABLE LAB
Provider Business Mailing Address
First Line : 21110 BISCAYNE BLVD
Second Line : STE 206
City : AVENTURA
State : FL
Zip : 33180-1227
Country : US
Telephone Number : 301-931-7884
Fax Number : 305-933-3203
Provider Business Practice Location Address
First Line : 21110 BISCAYNE BLVD
Second Line : STE 206
City : AVENTURA
State : FL
Zip : 33180-1227
Country : US
Telephone Number : 301-931-7884
Fax Number : 305-933-3203
Authorized Official
Title or Position : PRESIDENT
Name : MR. ENRIQUE HANABERGH
Credential : MD
Telephone Number : 305-931-7884
Provider Enumeration Date : 09/12/2005
Last Update Date : 09/11/2025

Similar Medicare Providers

1558349563 — MARK A FIRESTONE M.D.
Practice Location Address:
21110 BISCAYNE BLVD , 312
AVENTURA, FL
33180-1227
Practice Phone: 305-933-3030
Practice Fax: 305-933-1436
1518952936 — DANIEL N. WEINGRAD MD
Practice Location Address:
21110 BISCAYNE BLVD , SUITE 400
AVENTURA, FL
33180-1227
Practice Phone: 305-918-7050
Practice Fax: 305-918-7051
1396733655 — AMIKAM ZIGHELBOIM NIEMAN & GOODMAN MD P A
Practice Location Address:
21110 BISCAYNE BLVD , STE 303
AVENTURA, FL
33180-1227
Practice Phone: 305-466-0030
Practice Fax: 305-466-4755
1164411799 — DR. RICHARD M GOODMAN MD
Practice Location Address:
21110 BISCAYNE BLVD , SUITE 303
AVENTURA, FL
33180-1227
Practice Phone: 305-466-0030
Practice Fax: 305-466-4755
1740279363 — ROLAND E NIEMAN JR. MD
Practice Location Address:
21110 BISCAYNE BLVD , SUITE 303
AVENTURA, FL
33180-1227
Practice Phone: 305-466-0030
Practice Fax: 305-466-4755
1821087156 — DR. ENRIQUE HANABERGH M.D.
Practice Location Address:
21110 BISCAYNE BLVD , SUITE #206
AVENTURA, FL
33180-1227
Practice Phone: 305-933-2111
Practice Fax: 305-933-3203

Directions to “DIAGNOSTIC PORTABLE LAB ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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