1871615682 NPI number — INTEGRATIVE HEALTH CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871615682 NPI number — INTEGRATIVE HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATIVE HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871615682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13155 SW 42ND STREET
Provider Second Line Business Mailing Address:
SUIT 111 112
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33175-3428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-559-7063
Provider Business Mailing Address Fax Number:
305-559-7839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13155 SW 42ND STREET
Provider Second Line Business Practice Location Address:
SUIT 111 112
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33175-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-559-7063
Provider Business Practice Location Address Fax Number:
305-559-7839
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FERREIRA
Authorized Official First Name:
ISABEL
Authorized Official Middle Name:
ALTAGRACIA
Authorized Official Title or Position:
PEDIATRICIAN MEDICAL DIRECTOR
Authorized Official Telephone Number:
305-559-7063

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME57254 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009723000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051410100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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