Provider Demographics
NPI:1619849726
Name:SOUTH MIAMI DIAGNOSTIC CENTER LLC
Entity type:Organization
Organization Name:SOUTH MIAMI DIAGNOSTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-300-1093
Mailing Address - Street 1:7000 SW 62ND AVE STE 100B
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4717
Mailing Address - Country:US
Mailing Address - Phone:786-542-9844
Mailing Address - Fax:
Practice Address - Street 1:7000 SW 62ND AVE STE 100B
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4717
Practice Address - Country:US
Practice Address - Phone:786-542-9844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Multi-Specialty