Provider Demographics
NPI:1174588743
Name:HORIZON MOBILE DIAGNOSTIC INC
Entity type:Organization
Organization Name:HORIZON MOBILE DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-641-1501
Mailing Address - Street 1:201 NW 70TH AVE
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2369
Mailing Address - Country:US
Mailing Address - Phone:954-641-1501
Mailing Address - Fax:954-641-1506
Practice Address - Street 1:201 NW 70TH AVE
Practice Address - Street 2:SUITE D-1
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2369
Practice Address - Country:US
Practice Address - Phone:954-641-1501
Practice Address - Fax:954-641-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4464261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile