Provider Demographics
NPI:1780634477
Name:MOBILESONIC DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:MOBILESONIC DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIEVES
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-441-9201
Mailing Address - Street 1:1981 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3315
Mailing Address - Country:US
Mailing Address - Phone:305-441-9201
Mailing Address - Fax:305-441-0939
Practice Address - Street 1:1981 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3315
Practice Address - Country:US
Practice Address - Phone:305-441-9201
Practice Address - Fax:305-441-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2071261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8683Medicare ID - Type UnspecifiedPROVIDER NUMBER