Healthcare Provider Details

I. General information

NPI: 1982259107
Provider Name (Legal Business Name): ESTEVENZ CLINIC OF INTEGRATIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N UNIVERSITY DR STE A
CORAL SPRINGS FL
33065-5048
US

IV. Provider business mailing address

10874 CYPRESS GLEN DR
CORAL SPRINGS FL
33071-8160
US

V. Phone/Fax

Practice location:
  • Phone: 786-873-9686
  • Fax:
Mailing address:
  • Phone: 786-873-9686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JULIA BENITEZ-ESTEVENZ
Title or Position: OWNER
Credential:
Phone: 786-873-9686