Provider Demographics
NPI:1912682667
Name:TESLA MRI LLC
Entity Type:Organization
Organization Name:TESLA MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRGUETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-715-4689
Mailing Address - Street 1:3350 NW BOCA RATON BLVD STE B10
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6636
Mailing Address - Country:US
Mailing Address - Phone:883-837-5267
Mailing Address - Fax:888-385-6488
Practice Address - Street 1:2215 WINKLER AVE STE G
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9150
Practice Address - Country:US
Practice Address - Phone:833-837-5267
Practice Address - Fax:888-385-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)