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General NPI Number Information
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NPI Number | 1548648397
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Entity Type | Organization
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Legal Business Name | DELRAY CENTER FOR INTEGRATIVE MEDICINE PA
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 03/12/2021
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Provider Practice Location Address
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Address Line | 302 SE 2ND ST
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City | DELRAY BEACH
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State | FL
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Zip | 33483-4506
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Country | US
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Telephone | 561-332-1176
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Fax | 561-266-0033
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Provider Business Mailing Address
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Address Line | 403 SE 1ST ST
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City | DELRAY BEACH
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State | FL
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Zip | 33483-4540
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Country | US
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Telephone | 561-332-1776
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Fax | 561-266-0033
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAUL RODRIGUEZ
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Credential | M.D.
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Telephone | 561-266-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW9647
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | ME78266
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License Number State | FL
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