Provider Demographics
NPI:1922180355
Name:MEDICAL DIAGNOSTIC ASSOC
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARIDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-253-8370
Mailing Address - Street 1:42 NW 27TH AVENUE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126
Mailing Address - Country:US
Mailing Address - Phone:305-643-6858
Mailing Address - Fax:305-643-9298
Practice Address - Street 1:42 NW 27TH AVENUE
Practice Address - Street 2:SUITE 313
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126
Practice Address - Country:US
Practice Address - Phone:305-643-6858
Practice Address - Fax:305-643-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5094Medicare ID - Type Unspecified