Organization
TRI COUNTY PET LLC
Active
Other names
TRI County PET, LLC, PET Imaging Institute of South Fl.
Organization subpart
Yes
Provider details
NPI number
Authorized official
LISETTE CRUZ-DENO (MANAGING DIRECTOR)
(954) 981-6668
Entity
Organization
Contact information
Practice address
2122 W. CYPRESS CREEK ROAD, SUITE 210, FORT LAUDERDALE, FL 33309
(954) 981-6668
Mailing address
1150 N 35TH AVE STE 665, HOLLYWOOD, FL 33021-5432
(954) 981-6668
(954) 981-5944
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
HCC5507
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003906000
—
FL
05
—
003906001
—
FL
01
—
V2440
FLORIDA BLUE
FL
Enumeration date
03/06/2018
Last updated
04/11/2018
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