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General NPI Number Information
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NPI Number | 1760520654
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Entity Type | Organization
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Legal Business Name | SOUTH DADE ORTHOPEDIC- HOMESTEAD
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 957 N KROME AVE
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City | HOMESTEAD
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State | FL
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Zip | 33030-4408
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Country | US
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Telephone | 305-245-6866
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Fax |
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Provider Business Mailing Address
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Address Line | 3607 OLD CONEJO RD
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-2123
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ELLIOT LANG
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Credential |
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Telephone | 305-245-6866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | BL8501808
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License Number State | FL
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