Provider Demographics
NPI:1619276508
Name:IMAGEN DIAGNOSTIC SERVICES, INC.
Entity Type:Organization
Organization Name:IMAGEN DIAGNOSTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AYME
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-456-2162
Mailing Address - Street 1:3970 W FLAGLER ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1642
Mailing Address - Country:US
Mailing Address - Phone:305-456-2160
Mailing Address - Fax:305-456-0628
Practice Address - Street 1:3970 W FLAGLER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1642
Practice Address - Country:US
Practice Address - Phone:305-456-2160
Practice Address - Fax:305-456-0628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty