Executive Diagnostic Center

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

EXECUTIVE DIAGNOSTIC CENTER

Practice address

5211 NW 79TH Ave
Doral, FL 33166-4715

Phone

(305) 994-7343

Fax

(305) 994-7346

NPI assigned

Aug 26, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Leidy Diaz, OWNER

Title

President

Phone

(305) 994-7343

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314316800000",
    "number": "1609156231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5211 NW 79TH AVE",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331664715",
            "telephone_number": "305-994-7343",
            "fax_number": "305-994-7346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5211 NW 79TH AVE",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331664715",
            "telephone_number": "305-994-7343",
            "fax_number": "305-994-7346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE DIAGNOSTIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-26",
        "last_updated": "2011-08-26",
        "status": "A",
        "authorized_official_last_name": "DIAZ",
        "authorized_official_first_name": "LEIDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-994-7343",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFIED RADIOLOGY TECHNICIAN",
            "identifier": "CRT 77803",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA HEALTH DEPARTMENT",
            "identifier": "HCC 9220",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.