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General NPI Number Information
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NPI Number | 1205242047
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Entity Type | Organization
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Legal Business Name | DETOX SOLUTIONS OF THE PALM BEACHES
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 07/01/2014
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Provider Practice Location Address
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Address Line | 580 VILLAGE BLVD SUITE 210
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-1904
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Country | US
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Telephone | 561-491-4171
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Fax | 561-688-9565
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Provider Business Mailing Address
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Address Line | 580 VILLAGE BLVD SUITE 210
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-1904
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Country | US
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Telephone | 561-491-4171
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Fax | 561-688-9565
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DAVID L LIPORACE
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Credential | D.O
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Telephone | 561-491-4171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS5607
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License Number State | FL
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