Organization
ST. JOSEPH'S DIAGNOSTIC CENTER, LLC.
Active
Other names
BayCare Outpatient Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
TAMBLYN CUBERO (MANAGER)
(727) 281-9390
Entity
Organization
Contact information
Practice address
2222 W SWANN AVE, TAMPA, FL 33606-2426
(813) 554-8176
Mailing address
PO BOX 403800, ATLANTA, GA 30384-3800
(813) 852-3272
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
061048805
—
FL
Enumeration date
12/09/2013
Last updated
01/18/2019
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