Provider Demographics
NPI:1427229350
Name:DOUGLAS DIAGNOSTIC CENTER,INC
Entity type:Organization
Organization Name:DOUGLAS DIAGNOSTIC CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:786-290-4821
Mailing Address - Street 1:42 NW 27TH AVE STE 321B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-5135
Mailing Address - Country:US
Mailing Address - Phone:305-631-6606
Mailing Address - Fax:305-631-6590
Practice Address - Street 1:42 NW 27TH AVE STE 321B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-5135
Practice Address - Country:US
Practice Address - Phone:305-631-6606
Practice Address - Fax:305-631-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL646317-8261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center