Healthcare Provider Details

I. General information

NPI: 1376777839
Provider Name (Legal Business Name): INTEGRAL DEVELOPMENT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 07/21/2022
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 SW 122ND AVE STE 110
MIAMI FL
33186-5271
US

IV. Provider business mailing address

12700 SW 122ND AVE STE 110
MIAMI FL
33186-5271
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-2900
  • Fax: 786-364-1676
Mailing address:
  • Phone: 786-353-2900
  • Fax: 786-364-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. INGRID C SOSA
Title or Position: VICE-PRESIDENT
Credential:
Phone: 786-353-2900