Provider Demographics
NPI:1225454424
Name:PEMBROKE PINK IMAGING LLC
Entity Type:Organization
Organization Name:PEMBROKE PINK IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-740-5100
Mailing Address - Street 1:15735 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1207
Mailing Address - Country:US
Mailing Address - Phone:305-740-5100
Mailing Address - Fax:
Practice Address - Street 1:15735 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1207
Practice Address - Country:US
Practice Address - Phone:305-740-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITALMD GROUP HOLDING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-12
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty