Provider Demographics
NPI:1396494886
Name:SONOSCREENING GABLES CENTER LLC
Entity type:Organization
Organization Name:SONOSCREENING GABLES CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:LORIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-499-9923
Mailing Address - Street 1:75 VALENCIA AVE STE 704
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6132
Mailing Address - Country:US
Mailing Address - Phone:786-499-9923
Mailing Address - Fax:
Practice Address - Street 1:75 VALENCIA AVE STE 704
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6132
Practice Address - Country:US
Practice Address - Phone:786-499-9923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL36-4913348Medicaid