Healthcare Provider Details

I. General information

NPI: 1609597301
Provider Name (Legal Business Name): FAMILY INTEGRATIVE MEDICINE , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11251 S ORANGE BLOSSOM TRL STE 102
ORLANDO FL
32837-9297
US

IV. Provider business mailing address

11251 S ORANGE BLOSSOM TRL STE 101
ORLANDO FL
32837-9297
US

V. Phone/Fax

Practice location:
  • Phone: 407-501-6841
  • Fax: 407-542-2243
Mailing address:
  • Phone: 407-501-6841
  • Fax: 407-542-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: HERIBERTO L. RIVERA
Title or Position: CO-OWNER
Credential:
Phone: 407-288-3371