MEDICARE: WOMENS DIAGNOSTIC IMAGING 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	261Q00000X	Clinic/Center	HCC6585	FL

General Provider Information

NPI Number	:	1629196753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS DIAGNOSTIC IMAGING INC

Provider Business Mailing Address
First Line	:	3146 CORAL WAY
Second Line	:	SUITE # 201
City	:	MIAMI
State	:	FL
Zip	:	33145
Country	:	US
Telephone Number	:	305-444-8341
Fax Number	:	305-444-8342

Provider Business Practice Location Address
First Line	:	3146 CORAL WAY
Second Line	:	SUITE # 201
City	:	MIAMI
State	:	FL
Zip	:	33145
Country	:	US
Telephone Number	:	305-444-8341
Fax Number	:	305-444-8342

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ALEJANDRO E XIQUES
Credential	:
Telephone Number	:	305-444-8341

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	11/20/2007

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