Provider Demographics
NPI:1700108412
Name:ANGELS DIAGNOSTIC GROUP,INC
Entity Type:Organization
Organization Name:ANGELS DIAGNOSTIC GROUP,INC
Other - Org Name:ANGELS DIAGNOSTIC GROUP, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-593-8355
Mailing Address - Street 1:7500 NW 25TH ST STE 114
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1721
Mailing Address - Country:US
Mailing Address - Phone:305-593-8355
Mailing Address - Fax:305-593-8369
Practice Address - Street 1:7500 NW 25TH ST STE 114
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1721
Practice Address - Country:US
Practice Address - Phone:305-593-8355
Practice Address - Fax:305-593-8369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106242700Medicaid
FLHCC1215OtherHEALTH CARE CLINIC STANDARD