Provider Demographics
NPI:1316105414
Name:LIFE IMAGING INC
Entity type:Organization
Organization Name:LIFE IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:E
Authorized Official - Last Name:MANGA
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:305-342-2222
Mailing Address - Street 1:11988 SW 31ST CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7806
Mailing Address - Country:US
Mailing Address - Phone:305-342-2222
Mailing Address - Fax:
Practice Address - Street 1:11988 SW 31ST CT
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7806
Practice Address - Country:US
Practice Address - Phone:305-342-2222
Practice Address - Fax:866-775-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8179293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory