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General NPI Number Information
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NPI Number | 1396100343
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE HEALTH CARE INSTITUTE LLC
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Dates
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Enumeration Date | 12/17/2015
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 3211 PONCE DE LEON BLVD SUITE #102
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City | CORAL GABLES
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State | FL
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Zip | 33134-7274
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Country | US
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Telephone | 305-443-3480
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Fax |
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Provider Business Mailing Address
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Address Line | 3211 PONCE DE LEON BLVD SUITE #102
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City | CORAL GABLES
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State | FL
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Zip | 33134-7274
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Country | US
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Telephone | 305-443-3480
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MRS. MARITZA FUENTES
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Credential | MBR
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Telephone | 305-443-3480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 14000181260
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License Number State | FL
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