Provider Demographics
NPI:1306311337
Name:4D SOUND DIAGNOSTICS LLC
Entity type:Organization
Organization Name:4D SOUND DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:RT(R), RDMS(AB,OB),
Authorized Official - Phone:361-589-9711
Mailing Address - Street 1:4535 S PADRE ISLAND DR STE 8
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4417
Mailing Address - Country:US
Mailing Address - Phone:361-589-9711
Mailing Address - Fax:
Practice Address - Street 1:4535 S PADRE ISLAND DR STE 8
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4417
Practice Address - Country:US
Practice Address - Phone:361-589-9711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology