Provider Demographics
NPI:1619132388
Name:CYRUS DIAGNOSTIC IMAGING
Entity Type:Organization
Organization Name:CYRUS DIAGNOSTIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MASOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:VAHDATPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-321-3012
Mailing Address - Street 1:165 WAYMONT CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6093
Mailing Address - Country:US
Mailing Address - Phone:407-321-3012
Mailing Address - Fax:407-321-9006
Practice Address - Street 1:165 WAYMONT CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6093
Practice Address - Country:US
Practice Address - Phone:407-321-3012
Practice Address - Fax:407-321-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLW9922Medicare PIN