Provider Demographics
NPI:1932485901
Name:MIRIAM DIAGNOSTIC AND SERVICE INC
Entity Type:Organization
Organization Name:MIRIAM DIAGNOSTIC AND SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-328-5203
Mailing Address - Street 1:7822 SW 128TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4275
Mailing Address - Country:US
Mailing Address - Phone:786-328-5203
Mailing Address - Fax:305-433-4090
Practice Address - Street 1:7822 SW 128TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4275
Practice Address - Country:US
Practice Address - Phone:786-328-5203
Practice Address - Fax:305-433-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-22
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9257335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier