Healthcare Provider Details

I. General information

NPI: 1144247164
Provider Name (Legal Business Name): JAVIER FORTE R.D.M.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S HOMESTEAD BLVD SUITE 5
HOMESTEAD FL
33030-7351
US

IV. Provider business mailing address

27903 SW 160TH AVE
HOMESTEAD FL
33031-3022
US

V. Phone/Fax

Practice location:
  • Phone: 305-248-4888
  • Fax: 305-247-5367
Mailing address:
  • Phone: 305-248-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number606424-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: