DIAGNOSTIC PORTABLE LAB (NPI# 1407840937) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407840937 |
| Entity Type | Organization |
| Organization Name | DIAGNOSTIC PORTABLE LAB |
| Practice Address |
21110 Biscayne Blvd Ste 206 Aventura FL 33180-1227 |
| Practice Telephone | 3019317884 |
| Practice Fax Number | 3059333203 |
| Mailing Telephone | 3019317884 |
| Mailing Fax Number | 3059333203 |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. ENRIQUE HANABERGH (PRESIDENT) |
| Authorized Official Telephone | 3059317884 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 246XC2903X |
Spec/Tech, Cardiovascular Specialization: Vascular Specialist |
Technologists, Technicians & Other Technical Service Providers | ||
| X | 246XS1301X |
Spec/Tech, Cardiovascular Specialization: Sonography |
Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS | V1034 | 01 |
| Street Address |
21110 BISCAYNE BLVD STE 206 |
| City | AVENTURA |
| State | FL |
| Zip Code | 33180-1227 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730184045 | Lawrence T. Reese | Ophthalmology | 21110 Biscayne Blvd, Ste 403, Aventura, FL 33180-1252 | 2005-06-15 |
| 1578098653 | Karen Firesteone | Social Worker | 21110 Biscayne Blvd, Suite 304, Aventura, FL 33180-1229 | 2017-04-26 |
| 1043758212 | Brittany Grabois Schuman | Psychologist | 21110 Biscayne Blvd, Suite 304, Aventura, FL 33180-1227 | 2017-02-07 |
| 1033657200 | Bgs Psychological Services LLC | Psychologist | 21110 Biscayne Blvd, Suite 304, Aventura, FL 33180-1227 | 2017-02-07 |
| 1750739827 | Sara Hellman | Physician Assistant | 21110 Biscayne Blvd, Suite 405, Aventura, FL 33180-1227 | 2016-05-31 |
| 1083076558 | Rohit Gaikwad | Physical Therapist | 21110 Biscayne Blvd, 205, Aventura, FL 33180-1227 | 2016-03-24 |
| 1205297389 | Medical Consultants of Florida LLC | Non-Pharmacy Dispensing Site | 21110 Biscayne Blvd, 203, Aventura, FL 33180-1227 | 2016-03-16 |
| 1518328731 | Liza Isabel Lizarraga | Obstetrics & Gynecology | 21110 Biscayne Blvd, Suite 312, Aventura, FL 33180-1227 | 2016-03-15 |
| 1598135634 | Rufat Dasayev | Nurse Practitioner | 21110 Biscayne Blvd, Suite 303, Aventura, FL 33180-1227 | 2015-10-01 |
| 1427426113 | Genesiscare Usa of Florida LLC | Urology | 21110 Biscayne Blvd, Suite 401, Aventura, FL 33180-1227 | 2015-09-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720607849 | Nabeel Rahman Khan | Student in an Organized Health Care Education/Training Program | 20900 Biscayne Boulevard, Avetura, Fl, Aventura, FL 33180 | 2020-04-09 |
| 1235766841 | Hanny Hausmann | Counselor | 2999 Ne 191 Street, Suite 902, Aventura, FL 33180 | 2020-03-24 |
| 1760976369 | Michael Ernest Molino | Optometrist | 19575 Biscayne Blvd Ste 579, Aventura, FL 33180 | 2018-06-18 |
| 1932602620 | Carmen Somarriba | Physician Assistant | 21110 Biscayne Blvd Bldg Suite400, Aventura, FL 33180 | 2018-03-09 |
| 1235631474 | Premier Florida Podiatry, Pa | Podiatrist | 3060 Ne 190th St Apt 202, Aventura, FL 33180 | 2018-03-04 |
| 1891229126 | Ifrah Zahid Butt | Student in an Organized Health Care Education/Training Program | 20900 Biscayne Blvd., Aventura, FL 33180 | 2017-04-13 |
| 1629500129 | Hector Hugo Gonzalez | Student in an Organized Health Care Education/Training Program | 20900 Biscayne Blvd, South Tower, #807, Aventura Hospital and Medical Center, Aventura, FL 33180 | 2017-04-03 |
| 1457892671 | Nusen Beer | Internal Medicine | 20200 W Dixie Hwy Ste 701, Aventura, FL 33180 | 2017-03-20 |
| 1073052338 | Alfa Diagnostic LLC | Point of Service | 21355 E Dixie Hwy Ste 101, Aventura, FL 33180 | 2017-02-20 |
| 1598211740 | Katherine Mendez-martinez | Nurse Practitioner | 2925 Aventura Blvd. Suite 101, Aventura, FL 33180 | 2016-08-28 |
| Find all providers in zip 33180 | ||||
| Taxonomy Code | 246XC2903X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Spec/Tech, Cardiovascular |
| Specialization | Vascular Specialist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275926503 | Stephen Jackson | Spec/Tech, Cardiovascular | 2577 Sawgrass Lake Ct, Cape Coral, FL 33909-2935 | 2015-03-11 |
| 1780871004 | Juan C Galindo | Spec/Tech, Cardiovascular | 3271 Nw 7th St Ste 202, Miami, FL 33125-4141 | 2007-10-01 |
| 1104304385 | Shawn Marino | Spec/Tech, Cardiovascular | 926 Saxon Blvd, Orange City, FL 32763-8313 | 2018-07-31 |
| 1962898833 | Jeffrey Kent Raines | Spec/Tech, Cardiovascular | 9150 Sw 87th Ave, Suite 213, Miami, FL 33176-2319 | 2015-04-08 |
| 1679695027 | Antonio C Hernandez | Spec/Tech, Cardiovascular | 3360 Nw 72nd Ave, Miami, FL 33122-1320 | 2007-04-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.