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General NPI Number Information
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NPI Number | 1609449974
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Entity Type | Organization
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Legal Business Name | IRECOVERY, LLC
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Dates
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Enumeration Date | 07/23/2021
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 625 E TWIGGS ST # 1029
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City | TAMPA
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State | FL
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Zip | 33602-3931
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Country | US
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Telephone | 813-532-3323
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Fax | 561-464-5501
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Provider Business Mailing Address
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Address Line | 5030 CHAMPION BLVD STE G11-535
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City | BOCA RATON
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State | FL
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Zip | 33496-2473
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Country | US
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Telephone | 561-235-7683
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Fax | 561-464-5501
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MILDRED CINTRON
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Credential |
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Telephone | 561-235-7683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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