1407343015 NPI number — INTEGRATIVE HEALTHCARE OF SOUTH FLORIDA LLC

Table of content: (NPI 1407343015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407343015 NPI number — INTEGRATIVE HEALTHCARE OF SOUTH FLORIDA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATIVE HEALTHCARE OF SOUTH FLORIDA 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:
6
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:
1407343015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2098 NE 54TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33308-3158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-650-7662
Provider Business Mailing Address Fax Number:
954-901-2838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6152 VERDE TRL N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33433-2430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-388-0900
Provider Business Practice Location Address Fax Number:
954-901-2838
Provider Enumeration Date:
04/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
PHAM
Authorized Official First Name:
DINH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MEDICAL DOCTOR
Authorized Official Telephone Number:
954-650-7662

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  ME82117 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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