Healthcare Provider Details

I. General information

NPI: 1396766069
Provider Name (Legal Business Name): RHODE ISLAND INTEGRATED MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARK AVE
CRANSTON RI
02910-2346
US

IV. Provider business mailing address

521 PARK AVE
CRANSTON RI
02910-2346
US

V. Phone/Fax

Practice location:
  • Phone: 401-781-3374
  • Fax: 401-781-3376
Mailing address:
  • Phone: 401-781-3374
  • Fax: 401-781-3376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberNPP32472
License Number StateRI

VIII. Authorized Official

Name: DR. VICTOR M PEDRO
Title or Position: DIRECTOR
Credential: DC
Phone: 401-781-3374