Provider Demographics
NPI:1043095607
Name:RADIOLOGY DIAGNOSTIC MEDICAL IMAGING LLC
Entity type:Organization
Organization Name:RADIOLOGY DIAGNOSTIC MEDICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-922-1020
Mailing Address - Street 1:5200 SW 113TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2809
Mailing Address - Country:US
Mailing Address - Phone:954-533-7696
Mailing Address - Fax:
Practice Address - Street 1:7050 NW 4TH ST STE 204303
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2200
Practice Address - Country:US
Practice Address - Phone:954-292-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology