Provider Demographics
NPI:1710258504
Name:MP DIAGNOSTIC LTD
Entity Type:Organization
Organization Name:MP DIAGNOSTIC LTD
Other - Org Name:MRI AT SUNSET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF CORP GEN PART
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:POZO
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:305-271-8394
Mailing Address - Street 1:PO BOX 160608
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-0608
Mailing Address - Country:US
Mailing Address - Phone:786-242-8900
Mailing Address - Fax:786-923-2199
Practice Address - Street 1:6401 SW 87 AVENUE
Practice Address - Street 2:SUITE 121
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2520
Practice Address - Country:US
Practice Address - Phone:305-273-9290
Practice Address - Fax:786-923-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC98442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004623400Medicaid