Provider Demographics
NPI:1932625373
Name:HOMESTEAD MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:HOMESTEAD MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:ODALYS
Authorized Official - Middle Name:PILAR
Authorized Official - Last Name:FRONTELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-613-3192
Mailing Address - Street 1:704 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-6012
Mailing Address - Country:US
Mailing Address - Phone:786-536-3626
Mailing Address - Fax:305-274-5320
Practice Address - Street 1:704 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6012
Practice Address - Country:US
Practice Address - Phone:786-536-3626
Practice Address - Fax:305-274-5320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty