Organization
FLORIDA RADIOLOGY IMAGING AT LAKE MARY LLC
Active
Parent organization
FLORIDA RADIOLOGY IMAGING AT LAKE MARY LLC
Other names
Florida Radiology Imaging at Waterford Lakes, AdventHealth Imaging Waterford Lakes
Organization subpart
Yes
Provider details
NPI number
Legal business name
FLORIDA RADIOLOGY IMAGING AT LAKE MARY LLC
Authorized official
PEDRO RODRIGUEZ M.D. (MEDICAL DIRECTOR)
(407) 949-6444
Entity
Organization
Contact information
Practice address
12301 LAKE UNDERHILL ROAD, SUITE 103, ORLANDO, FL 32828
(407) 834-8722
Mailing address
900 WINDERLEY PL STE 2100, MAITLAND, FL 32751-4191
(407) 767-5028
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740256494
NPI BASE FOR GROUP
FL
05
—
2656442 04
—
FL
Enumeration date
04/10/2007
Last updated
06/20/2019
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