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General NPI Number Information
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NPI Number | 1609597301
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Entity Type | Organization
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Legal Business Name | FAMILY INTEGRATIVE MEDICINE , LLC
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 11251 S ORANGE BLOSSOM TRL STE 102
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City | ORLANDO
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State | FL
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Zip | 32837-9297
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Country | US
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Telephone | 407-501-6841
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Fax | 407-542-2243
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Provider Business Mailing Address
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Address Line | 11251 S ORANGE BLOSSOM TRL STE 101
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City | ORLANDO
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State | FL
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Zip | 32837-9297
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Country | US
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Telephone | 407-501-6841
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Fax | 407-542-2243
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Authorized Official
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Title or Position | CO-OWNER
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Name | HERIBERTO L. RIVERA
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Credential |
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Telephone | 407-288-3371
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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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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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