Healthcare Provider Details

I. General information

NPI: 1548051063
Provider Name (Legal Business Name): HOLISTIC ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 CAMINO GARDENS BLVD STE 101
BOCA RATON FL
33432-5828
US

IV. Provider business mailing address

399 CAMINO GARDENS BLVD. SUT. 101 STE 101
BOCA BOCA FL
33432
US

V. Phone/Fax

Practice location:
  • Phone: 561-672-5168
  • Fax:
Mailing address:
  • Phone: 561-672-5168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL LIVWEL
Title or Position: HOLISTIC HESALTH PRACTITIONER
Credential:
Phone: 561-672-5168