Provider Demographics
NPI:1588111488
Name:LIFE RADIOLOGY LLC
Entity type:Organization
Organization Name:LIFE RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-446-8541
Mailing Address - Street 1:5901 SW 114TH TER
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5030
Mailing Address - Country:US
Mailing Address - Phone:786-446-8541
Mailing Address - Fax:786-446-8542
Practice Address - Street 1:3470 NW 82ND AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1024
Practice Address - Country:US
Practice Address - Phone:786-446-8541
Practice Address - Fax:786-446-8542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84005261QM1200X, 261QR0206X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography