MEDICARE: LIGHTSTREAM MEDICAL INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	1313350	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932305851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTSTREAM MEDICAL INC.

Provider Business Mailing Address
First Line	:	1779 W 37TH ST UNIT 13
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4672
Country	:	US
Telephone Number	:	305-441-2501
Fax Number	:	305-513-5710

Provider Business Practice Location Address
First Line	:	1779 W 37TH ST UNIT 13
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4672
Country	:	US
Telephone Number	:	305-441-2501
Fax Number	:	305-513-5710

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. CHERI LYNN VALDIVIESO
Credential	:	J.D.
Telephone Number	:	305-441-2501

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	07/31/2023

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Directions to “LIGHTSTREAM MEDICAL INC. ” Practice Location

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