Healthcare Provider Details

I. General information

NPI: 1497971816
Provider Name (Legal Business Name): CORNERSTONE FAMILY HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 N CENTRAL AVE
UMATILLA FL
32784-8649
US

IV. Provider business mailing address

PO BOX 2470
UMATILLA FL
32784-2470
US

V. Phone/Fax

Practice location:
  • Phone: 352-516-1386
  • Fax: 352-669-0003
Mailing address:
  • Phone: 352-516-1386
  • Fax: 352-669-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. NICK G DIANGELIS
Title or Position: OWNER
Credential:
Phone: 352-516-1386