Provider Demographics
NPI:1548668908
Name:MD DIAGNOSTIC SERVICES LLC
Entity type:Organization
Organization Name:MD DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TECHNICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:ELESDANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO SANZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-285-9502
Mailing Address - Street 1:7405 SW 148TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1144
Mailing Address - Country:US
Mailing Address - Phone:786-285-9502
Mailing Address - Fax:
Practice Address - Street 1:7405 SW 148TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1144
Practice Address - Country:US
Practice Address - Phone:786-285-9502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL147114261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile