Provider Demographics
NPI:1821136623
Name:MIA DIAGNOSTICS OF SOUTH FLORIDA CORP
Entity Type:Organization
Organization Name:MIA DIAGNOSTICS OF SOUTH FLORIDA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-262-6143
Mailing Address - Street 1:9745 SW 72ND ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4652
Mailing Address - Country:US
Mailing Address - Phone:305-630-9252
Mailing Address - Fax:305-630-9241
Practice Address - Street 1:9745 SW 72ND ST
Practice Address - Street 2:SUITE 115
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4652
Practice Address - Country:US
Practice Address - Phone:305-630-9252
Practice Address - Fax:305-630-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC7500OtherHCC LICENSE