Organization
BROADER MRI OF FT PIERCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANGEL L SOTO (OWNER, PRESIDENT)
(954) 966-3600
Entity
Organization
Contact information
Practice address
2725 PETERS RD #37, FT.PIERCE, FL 34948
(954) 966-3600
(954) 967-1962
Mailing address
BROADER MRI OF FT PIERCE, LLC, 4224 HOLLYWOOD BLVD, HOLLYWOOD, FL 33021
(954) 966-3600
(954) 967-1962
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Enumeration date
02/13/2023
Last updated
02/13/2023
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