Provider Demographics
NPI:1124267133
Name:SUNDIAZ HOME CARE PROFESSIONALS LLC
Entity type:Organization
Organization Name:SUNDIAZ HOME CARE PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ-SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-961-7003
Mailing Address - Street 1:927 E NEW HAVEN AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5417
Mailing Address - Country:US
Mailing Address - Phone:321-961-7003
Mailing Address - Fax:321-728-0162
Practice Address - Street 1:927 E NEW HAVEN AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5417
Practice Address - Country:US
Practice Address - Phone:321-961-7003
Practice Address - Fax:321-728-0162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230612253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care