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General NPI Number Information
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NPI Number | 1528711561
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE HEALTHCARE ASSOCIATES LLC
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 4699 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-1830
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Country | US
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Telephone | 203-673-2061
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Fax |
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Provider Business Mailing Address
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Address Line | 53 COLUMBINE DR
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City | TRUMBULL
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State | CT
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Zip | 06611-4601
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Country | US
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Telephone | 203-673-2061
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | DR. JOSE LUIS LATORRE JR.
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Credential | DNP
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Telephone | 203-673-2061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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