Provider Demographics
NPI:1750829826
Name:ULTIMATE DIAGNOSTIC CENTER CORP
Entity Type:Organization
Organization Name:ULTIMATE DIAGNOSTIC CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JELLIEZET
Authorized Official - Middle Name:
Authorized Official - Last Name:OROZCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-393-8102
Mailing Address - Street 1:28870 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-2405
Mailing Address - Country:US
Mailing Address - Phone:305-393-8102
Mailing Address - Fax:305-359-3689
Practice Address - Street 1:28870 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-2405
Practice Address - Country:US
Practice Address - Phone:305-393-8102
Practice Address - Fax:305-359-3689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8773261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)