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General NPI Number Information
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NPI Number | 1598951477
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Entity Type | Organization
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Legal Business Name | IDEAL MEDICAL INC
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 199 EDGEWATER DR
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City | CORAL GABLES
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State | FL
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Zip | 33133-6912
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Country | US
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Telephone | 305-665-8942
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Fax |
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Provider Business Mailing Address
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Address Line | 199 EDGEWATER DR
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City | CORAL GABLES
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State | FL
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Zip | 33133-6912
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Country | US
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Telephone | 305-665-8942
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VANESSA LUISA PAGES
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Credential | PSY.D.
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Telephone | 305-665-8942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 6595
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License Number State | FL
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