Provider Demographics
NPI:1518925833
Name:DIMCOR OF SOUTH FLORIDA INC
Entity Type:Organization
Organization Name:DIMCOR OF SOUTH FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-904-6065
Mailing Address - Street 1:21050 NW 38 AVE
Mailing Address - Street 2:SUITE 1405
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4077
Mailing Address - Country:US
Mailing Address - Phone:305-904-6065
Mailing Address - Fax:305-682-1678
Practice Address - Street 1:259 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1854
Practice Address - Country:US
Practice Address - Phone:305-825-0893
Practice Address - Fax:305-682-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1768Medicare ID - Type Unspecified