Provider Demographics
NPI:1871781062
Name:SONOMD, INC.
Entity type:Organization
Organization Name:SONOMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:PORTUONDO
Authorized Official - Suffix:
Authorized Official - Credentials:BS, BA, RDCS, RVT
Authorized Official - Phone:561-758-2265
Mailing Address - Street 1:101 WEDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2908
Mailing Address - Country:US
Mailing Address - Phone:561-758-2265
Mailing Address - Fax:561-828-7633
Practice Address - Street 1:101 WEDGEWOOD CIR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-2908
Practice Address - Country:US
Practice Address - Phone:561-758-2265
Practice Address - Fax:561-828-7633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31334246XS1301X, 2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0344Medicare UPIN