Provider Demographics
NPI:1144247164
Name:FORTE, JAVIER (RDMS)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:FORTE
Suffix:
Gender:M
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27903 SW 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33031-3022
Mailing Address - Country:US
Mailing Address - Phone:305-248-4888
Mailing Address - Fax:
Practice Address - Street 1:701 S HOMESTEAD BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-7351
Practice Address - Country:US
Practice Address - Phone:305-248-4888
Practice Address - Fax:305-247-5367
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL606424-02471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography