Healthcare Provider Details

I. General information

NPI: 1811364557
Provider Name (Legal Business Name): FLORIDA CENTER FOR INTEGRATIVE HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 UNIVERSITY BLVD S SUITE 316
JACKSONVILLE FL
32216-2758
US

IV. Provider business mailing address

3100 UNIVERSITY BLVD S SUITE 316
JACKSONVILLE FL
32216-2758
US

V. Phone/Fax

Practice location:
  • Phone: 904-779-3901
  • Fax:
Mailing address:
  • Phone: 904-779-3901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME88914
License Number StateFL

VIII. Authorized Official

Name: DR. LUIS GALANO-LAVIN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 904-779-3901