Provider Demographics
NPI:1336236363
Name:CORAL GABLES MRI INC
Entity Type:Organization
Organization Name:CORAL GABLES MRI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-863-8860
Mailing Address - Street 1:PO BOX 440546
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-0546
Mailing Address - Country:US
Mailing Address - Phone:305-446-7893
Mailing Address - Fax:305-442-1183
Practice Address - Street 1:760 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2075
Practice Address - Country:US
Practice Address - Phone:305-446-7893
Practice Address - Fax:305-442-1183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370146800Medicaid
FL370146800Medicaid
FLE6711AMedicare PIN