Healthcare Provider Details

I. General information

NPI: 1659637551
Provider Name (Legal Business Name): INTEGRATED MEDICAL CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 SE OCEAN BLVD #215
STUART FL
34996-3310
US

IV. Provider business mailing address

2336 SE OCEAN BLVD #215
STUART FL
34996-3310
US

V. Phone/Fax

Practice location:
  • Phone: 561-247-9364
  • Fax:
Mailing address:
  • Phone: 561-247-9364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2815
License Number StateFL

VIII. Authorized Official

Name: SVETLANA VALEVSKI
Title or Position: CEO
Credential: DOM
Phone: 561-247-9364