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NPI Code Detail

MEDICARE: CHILDREN'S DIAGNOSTIC TESTING GROUP OF GABLES, INC.

MEDICARE: CHILDREN'S DIAGNOSTIC TESTING GROUP OF GABLES, 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
1261QM1200XMagnetic Resonance Imaging (MRI) Clinic/Center
2261QM1300XMulti-Specialty Clinic/Center
3261QR0200XRadiology Clinic/Center

General Provider Information

NPI Number : 1518177054
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDREN'S DIAGNOSTIC TESTING GROUP OF GABLES, INC.
Provider Business Mailing Address
First Line : 9485 SW 72ND ST
Second Line : SUITE A150
City : MIAMI
State : FL
Zip : 33173-3242
Country : US
Telephone Number : 305-275-6069
Fax Number : 305-412-8265
Provider Business Practice Location Address
First Line : 802 SW 37 AVENUE
Second Line : SUITE 150
City : CORAL GABLES
State : FL
Zip : 33134
Country : US
Telephone Number : 305-275-6069
Fax Number : 305-412-8265
Authorized Official
Title or Position : PRESIDENT
Name : MR. STEPHEN E CIANCIULLI
Credential :
Telephone Number : 305-275-6069
Provider Enumeration Date : 05/23/2007
Last Update Date : 09/11/2025

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