Provider Demographics
NPI:1376705913
Name:ADVANCE CARDIOVASCULAR IMAGING, INC
Entity Type:Organization
Organization Name:ADVANCE CARDIOVASCULAR IMAGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:DE VILLIERS
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS RVT CNMT
Authorized Official - Phone:786-287-2236
Mailing Address - Street 1:10260 SW 56TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7021
Mailing Address - Country:US
Mailing Address - Phone:305-270-7855
Mailing Address - Fax:305-270-7857
Practice Address - Street 1:10260 SW 56TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7021
Practice Address - Country:US
Practice Address - Phone:305-270-7855
Practice Address - Fax:305-270-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5326335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
W9957Medicare PIN