Healthcare Provider Details

I. General information

NPI: 1871615682
Provider Name (Legal Business Name): INTEGRATIVE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13155 SW 42ND STREET SUIT 111 112
MIAMI FL
33175-3428
US

IV. Provider business mailing address

13155 SW 42ND STREET SUIT 111 112
MIAMI FL
33175-3428
US

V. Phone/Fax

Practice location:
  • Phone: 305-559-7063
  • Fax: 305-559-7839
Mailing address:
  • Phone: 305-559-7063
  • Fax: 305-559-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME57254
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ISABEL ALTAGRACIA FERREIRA
Title or Position: PEDIATRICIAN MEDICAL DIRECTOR
Credential: MD
Phone: 305-559-7063