Provider Demographics
NPI:1659893634
Name:RADIOLOGY EXPRESS OF POINCIANA, LLC
Entity Type:Organization
Organization Name:RADIOLOGY EXPRESS OF POINCIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:SOLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-915-3564
Mailing Address - Street 1:1016 CYPRESS PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3328
Mailing Address - Country:US
Mailing Address - Phone:407-915-3564
Mailing Address - Fax:407-350-5967
Practice Address - Street 1:1016 CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3328
Practice Address - Country:US
Practice Address - Phone:407-915-3564
Practice Address - Fax:407-350-5967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty