Provider Demographics
NPI:1992378699
Name:PROHEALTH DIAGNOSTIC SERVICE CORP
Entity Type:Organization
Organization Name:PROHEALTH DIAGNOSTIC SERVICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FABIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-833-8278
Mailing Address - Street 1:601 SW 57TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3974
Mailing Address - Country:US
Mailing Address - Phone:305-833-8278
Mailing Address - Fax:305-402-4620
Practice Address - Street 1:601 SW 57TH AVE STE B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-3974
Practice Address - Country:US
Practice Address - Phone:305-833-8278
Practice Address - Fax:305-402-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty