Provider Demographics
NPI:1861652125
Name:MOBILE QUALITY DIAGNOSTIC CORP
Entity Type:Organization
Organization Name:MOBILE QUALITY DIAGNOSTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:RT, RVS
Authorized Official - Phone:305-820-8720
Mailing Address - Street 1:1751 W 38TH PL
Mailing Address - Street 2:UNIT 1003-A
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7021
Mailing Address - Country:US
Mailing Address - Phone:305-820-8720
Mailing Address - Fax:305-820-8721
Practice Address - Street 1:1751 W 38 PL
Practice Address - Street 2:UNIT 1003A
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7021
Practice Address - Country:US
Practice Address - Phone:305-820-8720
Practice Address - Fax:305-820-8721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7302335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1648Medicare PIN