Provider Demographics
NPI:1891717971
Name:HOMESTEAD DIAGNOSTIC CENTER INC
Entity type:Organization
Organization Name:HOMESTEAD DIAGNOSTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-246-5600
Mailing Address - Street 1:650 NE 22ND TER STE 100
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4710
Mailing Address - Country:US
Mailing Address - Phone:305-785-1048
Mailing Address - Fax:305-246-1320
Practice Address - Street 1:650 NE 22ND TER STE 100
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4710
Practice Address - Country:US
Practice Address - Phone:305-246-5600
Practice Address - Fax:305-246-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13-64-06259261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2443OtherBCBS
FL256719900Medicaid
FL266961OtherAVMED
FLV2443OtherBCBS