Provider Demographics
NPI:1215577069
Name:ALTAMONTE FAMILY HEARING LLC
Entity type:Organization
Organization Name:ALTAMONTE FAMILY HEARING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYSEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:HAS, BC-HIS
Authorized Official - Phone:305-967-3476
Mailing Address - Street 1:715 DOUGLAS AVE STE 45
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2576
Mailing Address - Country:US
Mailing Address - Phone:407-949-6737
Mailing Address - Fax:
Practice Address - Street 1:715 DOUGLAS AVE STE 45
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2576
Practice Address - Country:US
Practice Address - Phone:407-949-6737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022265000Medicaid