Provider Demographics
NPI:1952314940
Name:MILLENNIUM DIAGNOSTIC IMAGING CENTER, INC
Entity Type:Organization
Organization Name:MILLENNIUM DIAGNOSTIC IMAGING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LORENZO
Authorized Official - Last Name:GALARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-229-9511
Mailing Address - Street 1:8900 SW 24TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2075
Mailing Address - Country:US
Mailing Address - Phone:305-229-9511
Mailing Address - Fax:305-229-9112
Practice Address - Street 1:8900 SW 24TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2075
Practice Address - Country:US
Practice Address - Phone:305-229-9511
Practice Address - Fax:305-229-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4575261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272346OtherAMERIGROUP
FLV2847OtherBLUE CROSS BLUE SHIELD
FL261893100OtherFLORIDA NET PASS
FL246371OtherWELLCARE
FL261893100Medicaid
FL292178OtherAVMED
FL=========OtherAETNA
FL=========OtherUNITED HEALTHCARE
FL=========OtherPREFERRED CARE PARTNERS
FLV2847OtherBLUE CROSS BLUE SHIELD
FL246371OtherWELLCARE
FL261893100OtherFLORIDA NET PASS
FL=========OtherMULTIPLAN
FL292178OtherAVMED
FL=========OtherVISTA HEALTHPLAN
FL=========OtherPHCS
FL=========OtherMEDOPTION