Provider Demographics
NPI:1538147269
Name:MG NEUROVASCULAR ULTRASOUND SERV
Entity type:Organization
Organization Name:MG NEUROVASCULAR ULTRASOUND SERV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARLIN
Authorized Official - Middle Name:DANILA
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-644-1717
Mailing Address - Street 1:3383 NW 7TH ST
Mailing Address - Street 2:SUITE 107/108
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4140
Mailing Address - Country:US
Mailing Address - Phone:305-644-1795
Mailing Address - Fax:
Practice Address - Street 1:3383 NW 7TH ST
Practice Address - Street 2:SUITE 107/108
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4140
Practice Address - Country:US
Practice Address - Phone:305-644-1795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2471S1302X
FL247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Not Answered247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1699Medicare ID - Type UnspecifiedDIAGNOSTIC CENTER