Provider Demographics
NPI:1073612396
Name:HOMESTEAD MEDICAL DIAGNOSTIC INC
Entity Type:Organization
Organization Name:HOMESTEAD MEDICAL DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOVENIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-248-1481
Mailing Address - Street 1:225 S KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-7212
Mailing Address - Country:US
Mailing Address - Phone:305-248-1481
Mailing Address - Fax:305-248-1482
Practice Address - Street 1:225 S KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-7212
Practice Address - Country:US
Practice Address - Phone:305-248-1481
Practice Address - Fax:305-248-1482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary DiagnosticsGroup - Single Specialty