Provider Demographics
NPI:1225192263
Name:BREAST & ULTRASOUND DIAGNOSTIC SERVICES, INC.
Entity Type:Organization
Organization Name:BREAST & ULTRASOUND DIAGNOSTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:EXPOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-558-4140
Mailing Address - Street 1:4980 W 10TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3437
Mailing Address - Country:US
Mailing Address - Phone:305-558-4140
Mailing Address - Fax:305-558-9698
Practice Address - Street 1:4980 W 10TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3437
Practice Address - Country:US
Practice Address - Phone:305-558-4140
Practice Address - Fax:305-558-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC44092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257947OtherAVMED
FL170998OtherWELLCARE STAYWELL
FL77793OtherBCBS
FL216622OtherAMERIGROUP
FL77793OtherALL OTHERS
FL216622OtherAMERIGROUP