Provider Demographics
NPI:1265040604
Name:TOTAL MRI & DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:TOTAL MRI & DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:FLOREZ, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-756-3038
Mailing Address - Street 1:4440 SHERIDAN ST, STE B
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3535
Mailing Address - Country:US
Mailing Address - Phone:786-756-3038
Mailing Address - Fax:
Practice Address - Street 1:4440 SHERIDAN ST, STE B
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3535
Practice Address - Country:US
Practice Address - Phone:786-756-3038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGOtherAHCA LICENSE