Provider Demographics
NPI:1659429819
Name:WEST DIAGNOSTIC MEDICAL IMAGING
Entity Type:Organization
Organization Name:WEST DIAGNOSTIC MEDICAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:MACHADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-439-4877
Mailing Address - Street 1:6700 N ANDREWS AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2165
Mailing Address - Country:US
Mailing Address - Phone:954-636-3406
Mailing Address - Fax:
Practice Address - Street 1:6700 N ANDREWS AVE STE 109
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2165
Practice Address - Country:US
Practice Address - Phone:954-636-3406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty