Provider Demographics
NPI:1073052338
Name:ALFA DIAGNOSTIC LLC
Entity Type:Organization
Organization Name:ALFA DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMAA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-688-3540
Mailing Address - Street 1:21355 E DIXIE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1239
Mailing Address - Country:US
Mailing Address - Phone:305-705-4775
Mailing Address - Fax:
Practice Address - Street 1:21355 E DIXIE HWY STE 101
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1239
Practice Address - Country:US
Practice Address - Phone:305-705-4775
Practice Address - Fax:786-955-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography