Provider Demographics
NPI:1932305851
Name:LIGHTSTREAM MEDICAL INC.
Entity Type:Organization
Organization Name:LIGHTSTREAM MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VALDIVIESO
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:305-441-2501
Mailing Address - Street 1:1779 W 37TH ST UNIT 13
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4672
Mailing Address - Country:US
Mailing Address - Phone:305-441-2501
Mailing Address - Fax:305-513-5710
Practice Address - Street 1:1779 W 37TH ST UNIT 13
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4672
Practice Address - Country:US
Practice Address - Phone:305-441-2501
Practice Address - Fax:305-513-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313350332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5985010001Medicare NSC