Provider Demographics
NPI:1073752242
Name:ECLIPSE MEDICAL DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:ECLIPSE MEDICAL DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:P
Authorized Official - Last Name:TRETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-999-6511
Mailing Address - Street 1:429 LENOX AVE
Mailing Address - Street 2:STE 4C20
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6532
Mailing Address - Country:US
Mailing Address - Phone:786-999-6511
Mailing Address - Fax:
Practice Address - Street 1:429 LENOX AVE
Practice Address - Street 2:STE 4C20
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6532
Practice Address - Country:US
Practice Address - Phone:786-999-6511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile