Healthcare Provider Details

I. General information

NPI: 1023876232
Provider Name (Legal Business Name): ACCESSIBLE INTEGRATIVE MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14205 PARK CENTER DR STE 201
LAUREL MD
20707-5252
US

IV. Provider business mailing address

20 COURTHOUSE SQ STE 204
ROCKVILLE MD
20850-2338
US

V. Phone/Fax

Practice location:
  • Phone: 301-962-4278
  • Fax:
Mailing address:
  • Phone: 301-962-4278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN GONZALEZ-COTA
Title or Position: CEO
Credential:
Phone: 301-962-4278