Provider Demographics
NPI:1992900880
Name:LAM MOBILE DIAGNOSTIC INC
Entity type:Organization
Organization Name:LAM MOBILE DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-805-0014
Mailing Address - Street 1:435 HIALEAH DR
Mailing Address - Street 2:UPSTAIRS OFFFICE #6
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5358
Mailing Address - Country:US
Mailing Address - Phone:305-805-0014
Mailing Address - Fax:305-805-0445
Practice Address - Street 1:435 HIALEAH DR
Practice Address - Street 2:UPSTAIRS OFFFICE #6
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5358
Practice Address - Country:US
Practice Address - Phone:305-805-0014
Practice Address - Fax:305-805-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier