Provider Demographics
NPI:1558783621
Name:DIAGNOSTIC CENTER OF TAMPA
Entity Type:Organization
Organization Name:DIAGNOSTIC CENTER OF TAMPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ BARREIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-304-0140
Mailing Address - Street 1:4040 W WATERS AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-8149
Mailing Address - Country:US
Mailing Address - Phone:813-304-0140
Mailing Address - Fax:813-200-2161
Practice Address - Street 1:4040 W WATERS AVE STE 107
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-8149
Practice Address - Country:US
Practice Address - Phone:813-304-0140
Practice Address - Fax:813-200-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center