Provider Demographics
NPI:1861033078
Name:DE LA PEDRAJA RADIOLOGY ASSOC., INC
Entity Type:Organization
Organization Name:DE LA PEDRAJA RADIOLOGY ASSOC., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:DE LA PEDRAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-447-1415
Mailing Address - Street 1:4776 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2564
Mailing Address - Country:US
Mailing Address - Phone:305-447-1415
Mailing Address - Fax:305-446-2435
Practice Address - Street 1:4776 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2564
Practice Address - Country:US
Practice Address - Phone:305-447-1415
Practice Address - Fax:305-446-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology