Provider Demographics
NPI:1811024680
Name:SOUTHERN DIAGNOSTIC INC
Entity Type:Organization
Organization Name:SOUTHERN DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-642-7767
Mailing Address - Street 1:5941 NW 173RD DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5109
Mailing Address - Country:US
Mailing Address - Phone:305-642-7767
Mailing Address - Fax:
Practice Address - Street 1:5941 NW 173RD DR
Practice Address - Street 2:SUITE 2
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5109
Practice Address - Country:US
Practice Address - Phone:305-642-7767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty