Provider Demographics
NPI:1801810494
Name:CARDIOVASCULAR DIAGNOSTIC IMAGING
Entity type:Organization
Organization Name:CARDIOVASCULAR DIAGNOSTIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRABOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-595-4136
Mailing Address - Street 1:10621 N KENDALL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1530
Mailing Address - Country:US
Mailing Address - Phone:305-595-4136
Mailing Address - Fax:305-596-0668
Practice Address - Street 1:10621 N KENDALL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1530
Practice Address - Country:US
Practice Address - Phone:305-595-4136
Practice Address - Fax:305-596-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1611Medicare ID - Type Unspecified