Provider Demographics
NPI:1912759689
Name:MOBILE X IMAGING
Entity Type:Organization
Organization Name:MOBILE X IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIC TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:ANDREZ
Authorized Official - Last Name:CANDELARIA
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:786-339-1603
Mailing Address - Street 1:4900 SAINT HELENA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33898-7520
Mailing Address - Country:US
Mailing Address - Phone:786-339-1603
Mailing Address - Fax:
Practice Address - Street 1:4900 SAINT HELENA RD
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33898-7520
Practice Address - Country:US
Practice Address - Phone:786-339-1603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty