Provider Demographics
NPI:1164489852
Name:ADVANCED IMAGING SERVICES,INC.
Entity Type:Organization
Organization Name:ADVANCED IMAGING SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRISEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS,RDCS,RVT
Authorized Official - Phone:305-318-4571
Mailing Address - Street 1:475 BILTMORE WAY
Mailing Address - Street 2:#200
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5755
Mailing Address - Country:US
Mailing Address - Phone:305-442-2029
Mailing Address - Fax:
Practice Address - Street 1:475 BILTMORE WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5755
Practice Address - Country:US
Practice Address - Phone:305-442-2029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5695261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology