MEDICARE: DIMCOR OF SOUTH FLORIDA 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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1518925833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIMCOR OF SOUTH FLORIDA INC

Provider Business Mailing Address
First Line	:	21050 NW 38 AVE
Second Line	:	SUITE 1405
City	:	AVENTURA
State	:	FL
Zip	:	33180-4077
Country	:	US
Telephone Number	:	305-904-6065
Fax Number	:	305-682-1678

Provider Business Practice Location Address
First Line	:	259 E 49TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-1854
Country	:	US
Telephone Number	:	305-825-0893
Fax Number	:	305-682-1678

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	MARCOS SEVILLA
Credential	:
Telephone Number	:	305-904-6065

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	12/04/2012

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Directions to “DIMCOR OF SOUTH FLORIDA INC ” Practice Location

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