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General NPI Number Information
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NPI Number | 1528633047
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Entity Type | Organization
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Legal Business Name | DRFICO INTEGRATIVE MEDICINE AND FUNCTIONAL GASTROENTEROLOGY CENTER
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 7100 W 20TH AVE STE 106
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City | HIALEAH
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State | FL
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Zip | 33016-1813
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Country | US
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Telephone | 347-964-2817
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Fax |
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Provider Business Mailing Address
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Address Line | 8350 SW 131ST ST
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City | PINECREST
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State | FL
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Zip | 33156-6656
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Country | US
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Telephone | 347-964-2817
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | FRANCISCO D BAUTISTA-MENA
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Credential | MD
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Telephone | 347-964-2817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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