Provider Demographics
NPI:1548270341
Name:PRO DIAGNOSTIC IMAGING INC
Entity type:Organization
Organization Name:PRO DIAGNOSTIC IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIXON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-940-6077
Mailing Address - Street 1:2020 NE 163RD STREET
Mailing Address - Street 2:SUITE 208C
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162
Mailing Address - Country:US
Mailing Address - Phone:305-940-6077
Mailing Address - Fax:305-945-9856
Practice Address - Street 1:2020 NE 163RD STREET
Practice Address - Street 2:SUITE 208C
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162
Practice Address - Country:US
Practice Address - Phone:305-940-6077
Practice Address - Fax:305-945-9856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
X70825Medicare UPIN
E7189Medicare ID - Type Unspecified