1992068241 NPI number — INTEGRATIVE METHODS LLC

Table of content: (NPI 1992068241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992068241 NPI number — INTEGRATIVE METHODS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATIVE METHODS LLC
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:
1992068241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 297883
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33029-7883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-774-7729
Provider Business Mailing Address Fax Number:
954-391-8176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 NW 41ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33166-6205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-774-7729
Provider Business Practice Location Address Fax Number:
954-391-8176
Provider Enumeration Date:
06/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DIETSCH-VAZQUEZ
Authorized Official First Name:
LILIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
786-774-7729

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  BACB 1-08-4716 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: OT 11239 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 017426700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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