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General NPI Number Information
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NPI Number | 1356818637
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Entity Type | Organization
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Legal Business Name | MEDICUS HEALTH PLAN, INC.
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Dates
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Enumeration Date | 10/25/2018
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 9980 CENTRAL PARK BLVD N STE 116
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City | BOCA RATON
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State | FL
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Zip | 33428-1703
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Country | US
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Telephone | 866-731-6777
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Fax | 954-845-0416
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Provider Business Mailing Address
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Address Line | 9980 CENTRAL PARK BLVD N STE 116
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City | BOCA RATON
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State | FL
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Zip | 33428-1703
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Country | US
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Telephone | 866-731-6777
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Fax | 954-845-0416
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Authorized Official
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Title or Position | OWNER / M.D
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Name | FERNANDO M LOPEZ-IVERN
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Credential | MD
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Telephone | 866-731-6777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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