Healthcare Provider Details

I. General information

NPI: 1215420849
Provider Name (Legal Business Name): NEURO INTERGRATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7731 N MILITARY TRL
WEST PALM BEACH FL
33410-7430
US

IV. Provider business mailing address

125 NEPTUNE DR
HYPOLUXO FL
33462-6019
US

V. Phone/Fax

Practice location:
  • Phone: 561-721-9696
  • Fax: 954-856-2904
Mailing address:
  • Phone: 561-504-2305
  • Fax: 954-856-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: SILVIA V HERNANDEZ
Title or Position: MANAGER
Credential:
Phone: 954-203-3584