Organization
EXECUTIVE DIAGNOSTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LEIDY DIAZ OWNER (PRESIDENT)
(305) 994-7343
Entity
Organization
Contact information
Practice address
5211 NW 79TH AVE, DORAL, FL 33166-4715
(305) 994-7343
(305) 994-7346
Mailing address
5211 NW 79TH AVE, DORAL, FL 33166-4715
(305) 994-7343
(305) 994-7346
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CRT 77803
CERTIFIED RADIOLOGY TECHNICIAN
FL
01
—
HCC 9220
FLORIDA HEALTH DEPARTMENT
FL
Enumeration date
08/26/2011
Last updated
08/26/2011
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