Active Diagnostic Imaging LLC

Primary specialty

Sonography Radiologic TechnologistTaxonomy code 2471S1302X

License

L08000017078 Issued in FL

Legal business name

ACTIVE DIAGNOSTIC IMAGING LLC

Practice address

3110 W Gray St
Tampa, FL 33609-1516

Phone

(813) 348-0049

NPI assigned

Mar 3, 2008

Organization subpart

No

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

Authorized official

Name

Miss Jessica Villegas, RDMS

Title

President

Phone

(813) 348-0049

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1204502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204588800000",
    "number": "1700056009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 320905",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336792905",
            "telephone_number": "813-348-0049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 W GRAY ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336091516",
            "telephone_number": "813-348-0049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE DIAGNOSTIC IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-03",
        "last_updated": "2008-03-04",
        "status": "A",
        "authorized_official_last_name": "VILLEGAS",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-348-0049",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "RDMS"
    },
    "taxonomies": [
        {
            "code": "2471S1302X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Sonography",
            "state": "FL",
            "license": "L08000017078",
            "primary": true
        },
        {
            "code": "2471V0105X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Vascular Sonography",
            "state": "FL",
            "license": "L08000017078",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sonography Radiologic Technologist in Tampa, FL
• Providers in Tampa, FL by specialty
• Sonography Radiologic Technologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; 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.