Provider Demographics
NPI:1831242866
Name:UNIVERSITY DIAGNOSTIC CENTER, INC.
Entity type:Organization
Organization Name:UNIVERSITY DIAGNOSTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FOUAD
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:SCANDAR
Authorized Official - Suffix:
Authorized Official - Credentials:CNMT
Authorized Official - Phone:305-442-4122
Mailing Address - Street 1:2710 SW 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2728
Mailing Address - Country:US
Mailing Address - Phone:305-442-4122
Mailing Address - Fax:
Practice Address - Street 1:2710 SW 37TH AVE
Practice Address - Street 2:
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133-2728
Practice Address - Country:US
Practice Address - Phone:305-442-4122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology