Healthcare Provider Details

I. General information

NPI: 1346221611
Provider Name (Legal Business Name): HOMESTEAD PORTABLE X-RAY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 NW 7TH ST SUITE 3
MIAMI FL
33126-2252
US

IV. Provider business mailing address

4700 NW 7TH ST SUITE 3
MIAMI FL
33126-2252
US

V. Phone/Fax

Practice location:
  • Phone: 786-866-9737
  • Fax: 786-866-5933
Mailing address:
  • Phone: 786-866-9737
  • Fax: 786-866-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. KAADIR HERRERA ORTEGA
Title or Position: PRESIDENT
Credential:
Phone: 786-866-9737