Healthcare Provider Details

I. General information

NPI: 1861089062
Provider Name (Legal Business Name): JACKSONVILLE INTEGRATIVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13241 BARTRAM PARK BLVD UNIT 2501
JACKSONVILLE FL
32258-5218
US

IV. Provider business mailing address

13241 BARTRAM PARK BLVD UNIT 2501
JACKSONVILLE FL
32258-5218
US

V. Phone/Fax

Practice location:
  • Phone: 904-299-6000
  • Fax: 904-299-6001
Mailing address:
  • Phone: 904-621-4222
  • Fax: 904-299-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL BUSQUETS
Title or Position: OWNER
Credential:
Phone: 904-621-4222