Provider Demographics
NPI:1235118001
Name:DIMENSIONAL DIAGNOSTIC IMAGING
Entity type:Organization
Organization Name:DIMENSIONAL DIAGNOSTIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-836-1081
Mailing Address - Street 1:664 E 25TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3805
Mailing Address - Country:US
Mailing Address - Phone:305-836-1081
Mailing Address - Fax:305-836-6481
Practice Address - Street 1:664 E 25TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3805
Practice Address - Country:US
Practice Address - Phone:305-836-1081
Practice Address - Fax:305-836-6481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5859261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3097Medicare ID - Type UnspecifiedIDTF