Healthcare Provider Details

I. General information

NPI: 1003087461
Provider Name (Legal Business Name): INTERNATIONAL MEDICAL COLLABORATIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2337 S UNIVERSITY DR
DAVIE FL
33324-5842
US

IV. Provider business mailing address

2337 S UNIVERSITY DR
DAVIE FL
33324-5842
US

V. Phone/Fax

Practice location:
  • Phone: 954-423-9234
  • Fax: 954-423-9231
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANK C HERNANDEZ
Title or Position: PRESIDENT
Credential:
Phone: 954-423-9234