Provider Demographics
NPI:1407041957
Name:WESTCOAST DIAGNOSTIC IMAGING CENTER INC
Entity Type:Organization
Organization Name:WESTCOAST DIAGNOSTIC IMAGING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:L
Authorized Official - Last Name:CATRAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-369-0770
Mailing Address - Street 1:1495 S VOLUSIA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7047
Mailing Address - Country:US
Mailing Address - Phone:386-774-5211
Mailing Address - Fax:386-774-5251
Practice Address - Street 1:410 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1100
Practice Address - Country:US
Practice Address - Phone:352-369-0770
Practice Address - Fax:352-369-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058418174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty