Provider Demographics
NPI:1124208673
Name:HK DIAGNOSTIC CENTER INC
Entity Type:Organization
Organization Name:HK DIAGNOSTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-871-8014
Mailing Address - Street 1:6595 NW 36TH ST
Mailing Address - Street 2:SUITE 316
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6979
Mailing Address - Country:US
Mailing Address - Phone:305-871-8014
Mailing Address - Fax:305-871-8017
Practice Address - Street 1:6595 NW 36TH ST
Practice Address - Street 2:SUITE 316
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6979
Practice Address - Country:US
Practice Address - Phone:305-871-8014
Practice Address - Fax:305-871-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6782261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center