Provider Demographics
NPI:1689924292
Name:BREAST DIAGNOSTICS
Entity Type:Organization
Organization Name:BREAST DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIAGGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-932-0282
Mailing Address - Street 1:21355 E DIXIE HWY
Mailing Address - Street 2:#117
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1238
Mailing Address - Country:US
Mailing Address - Phone:305-932-0282
Mailing Address - Fax:877-635-1453
Practice Address - Street 1:21355 E DIXIE HWY
Practice Address - Street 2:#117
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1238
Practice Address - Country:US
Practice Address - Phone:305-932-0282
Practice Address - Fax:877-635-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43242305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96367Medicare PIN