Provider Demographics
NPI:1205164902
Name:LG DIAGNOSTIC CENTER INC
Entity type:Organization
Organization Name:LG DIAGNOSTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-508-8408
Mailing Address - Street 1:4155 SW 130 AV
Mailing Address - Street 2:STE 211
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3417
Mailing Address - Country:US
Mailing Address - Phone:305-227-2278
Mailing Address - Fax:305-227-2273
Practice Address - Street 1:4155 SW 130TH AVE
Practice Address - Street 2:STE 211
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3414
Practice Address - Country:US
Practice Address - Phone:305-227-2278
Practice Address - Fax:305-227-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile