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General NPI Number Information
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NPI Number | 1457994261
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Entity Type | Organization
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Legal Business Name | INTELLIHEALTH MEDICAL
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Dates
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Enumeration Date | 10/24/2019
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 3280 TAMIAMI TRL # 55A-294
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8053
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Country | US
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Telephone | 323-684-7024
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Fax |
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Provider Business Mailing Address
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Address Line | 3280 TAMIAMI TRL # 55A-294
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8053
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Country | US
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Telephone | 323-684-7024
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ESTEFANIA PEREZ
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Credential |
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Telephone | 323-684-7024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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