Provider Demographics
NPI:1700269784
Name:IMAGING NATION DIAGNOSTICS CORP
Entity type:Organization
Organization Name:IMAGING NATION DIAGNOSTICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-353-9160
Mailing Address - Street 1:1250 SW 27TH AVE STE 303
Mailing Address - Street 2:303
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4749
Mailing Address - Country:US
Mailing Address - Phone:786-353-9160
Mailing Address - Fax:786-580-3174
Practice Address - Street 1:1250 SW 27TH AVE STE 303
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4749
Practice Address - Country:US
Practice Address - Phone:786-353-9160
Practice Address - Fax:786-580-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10377261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC10377OtherAHCA