Healthcare Provider Details

I. General information

NPI: 1639578834
Provider Name (Legal Business Name): INTEGRATED HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SW 57TH AVE STE 106
MIAMI FL
33155-2164
US

IV. Provider business mailing address

1890 SW 57TH AVE STE 106
MIAMI FL
33155-2164
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-1701
  • Fax:
Mailing address:
  • Phone: 786-536-1701
  • Fax: 305-847-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME121113
License Number StateFL

VIII. Authorized Official

Name: MAYTE RUIZ SANTIAGO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-200-7681