| Entity Name: | CORAL GABLES MRI, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 27 Feb 1992 (33 years ago) |
| Document Number: | V18363 |
| FEI/EIN Number | 650334496 |
| Mail Address: | 780 NW 42ND AVE, MIAMI, FL, 33126-5536, US |
| Address: | 747 PONCE DE LEON BLVD, CORAL GABLES, FL, 33134, US |
| ZIP code: | 33134 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336236363 | 2006-10-10 | 2016-04-15 | PO BOX 440546, MIAMI, FL, 331440546, US | 760 PONCE DE LEON BLVD, CORAL GABLES, FL, 331342075, US | |||||||||||||||||||||||||
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| Phone | +1 305-446-7893 |
| Fax | 3054421183 |
Authorized person
| Name | MR. WILFRED BRACERAS |
| Role | PRESIDENT |
| Phone | 3058638860 |
Taxonomy
| Taxonomy Code | 261QM1200X - Magnetic Resonance Imaging (MRI) Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QS1200X - Sleep Disorder Diagnostic Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 370146800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRACERAS WILFRED | Agent | 780 NW 42ND AVE, MIAMI, FL, 331265536 |
| Name | Role | Address |
|---|---|---|
| WILFRED BRACERAS | President | 780 NW 42ND AVE, MIAMI, FL, 331265536 |
| Name | Role | Address |
|---|---|---|
| WILFRED BRACERAS | Secretary | 780 NW 42ND AVE, MIAMI, FL, 331265536 |
| Name | Role | Address |
|---|---|---|
| WILFRED BRACERAS | Treasurer | 780 NW 42ND AVE, MIAMI, FL, 331265536 |
| Name | Role | Address |
|---|---|---|
| WILFRED BRACERAS | Director | 780 NW 42ND AVE, MIAMI, FL, 331265536 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
