Provider Demographics
NPI:1972840551
Name:DM DIAGNOSTIC MEDICAL CENTER INC
Entity type:Organization
Organization Name:DM DIAGNOSTIC MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DULCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-335-6208
Mailing Address - Street 1:11117 W OKEECHOBEE RD
Mailing Address - Street 2:STE 11114
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4212
Mailing Address - Country:US
Mailing Address - Phone:786-335-6208
Mailing Address - Fax:786-335-6225
Practice Address - Street 1:11117 W OKEECHOBEE RD
Practice Address - Street 2:STE 11114
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4212
Practice Address - Country:US
Practice Address - Phone:786-335-6208
Practice Address - Fax:786-335-6225
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DM DIAGNOSTIC MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty