Provider Demographics
NPI:1184640633
Name:MIAMI MEDICAL IMAGING INC
Entity Type:Organization
Organization Name:MIAMI MEDICAL IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUEBLA LLANOS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:305-554-9599
Mailing Address - Street 1:PO BOX 660127
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33266-0127
Mailing Address - Country:US
Mailing Address - Phone:305-554-9599
Mailing Address - Fax:305-554-9599
Practice Address - Street 1:15387 SW 15TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2671
Practice Address - Country:US
Practice Address - Phone:305-554-9599
Practice Address - Fax:305-554-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV1794OtherBC/BS OF FL PROVIDER NO.
FLE1453Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER