Provider Demographics
NPI:1568404796
Name:PRESTIGE DIAGNOSTIC CORP
Entity Type:Organization
Organization Name:PRESTIGE DIAGNOSTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LOO
Authorized Official - Last Name:FIGUEREDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-639-0505
Mailing Address - Street 1:6447 MIAMI LAKES DR
Mailing Address - Street 2:SUITE 210C
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2760
Mailing Address - Country:US
Mailing Address - Phone:786-639-0505
Mailing Address - Fax:786-639-0555
Practice Address - Street 1:6447 MIAMI LAKES DR
Practice Address - Street 2:SUITE 210C
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2760
Practice Address - Country:US
Practice Address - Phone:786-639-0505
Practice Address - Fax:786-639-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary DiagnosticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1119Medicare ID - Type UnspecifiedPROVIDER NUMBER