Healthcare Provider Details

I. General information

NPI: 1003132143
Provider Name (Legal Business Name): BOCA INTEGRATIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W CAMINO REAL STE. 207
BOCA RATON FL
33433-5510
US

IV. Provider business mailing address

7100 W CAMINO REAL STE. 207
BOCA RATON FL
33433-5510
US

V. Phone/Fax

Practice location:
  • Phone: 561-391-2770
  • Fax: 561-391-2930
Mailing address:
  • Phone: 561-391-2770
  • Fax: 561-391-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW JED RADER
Title or Position: CEO
Credential: JD
Phone: 561-391-2770