Provider Demographics
NPI:1669656955
Name:SALMO 112 DIAGNOSTIC CENTER INC
Entity Type:Organization
Organization Name:SALMO 112 DIAGNOSTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SABAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-220-1254
Mailing Address - Street 1:35 SW 114TH AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1002
Mailing Address - Country:US
Mailing Address - Phone:305-220-1254
Mailing Address - Fax:305-220-1255
Practice Address - Street 1:35 SW 114TH AVE
Practice Address - Street 2:STE 206
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1002
Practice Address - Country:US
Practice Address - Phone:305-220-1254
Practice Address - Fax:305-220-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7943261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center