Provider Demographics
NPI:1790080679
Name:ROYAL DIAGNOSTIC CENTER, INC.
Entity Type:Organization
Organization Name:ROYAL DIAGNOSTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-242-9700
Mailing Address - Street 1:2002 DEL PRADO BLVD S
Mailing Address - Street 2:SUITE #103
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-4557
Mailing Address - Country:US
Mailing Address - Phone:239-242-9700
Mailing Address - Fax:239-242-2467
Practice Address - Street 1:2002 DEL PRADO BLVD S
Practice Address - Street 2:SUITE #103
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-4557
Practice Address - Country:US
Practice Address - Phone:239-242-9700
Practice Address - Fax:239-242-6497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC92012471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty