Provider Demographics
NPI:1114321551
Name:DIAGNSOTIC MEDICAL IMAGING OF PEMBROKE PINES LLC
Entity Type:Organization
Organization Name:DIAGNSOTIC MEDICAL IMAGING OF PEMBROKE PINES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMONISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOLANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-780-5566
Mailing Address - Street 1:6517 TAFT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4062
Mailing Address - Country:US
Mailing Address - Phone:954-780-5566
Mailing Address - Fax:954-780-5567
Practice Address - Street 1:330 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1770
Practice Address - Country:US
Practice Address - Phone:954-780-5566
Practice Address - Fax:954-780-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology