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General NPI Number Information
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NPI Number | 1720572456
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Entity Type | Organization
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Legal Business Name | FAMILY INTEGRATIVE MEDICINE OF ORLANDO
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Dates
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Enumeration Date | 06/16/2018
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 11301 S ORANGE BLOSSOM TRL STE A208
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City | ORLANDO
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State | FL
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Zip | 32837
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Country | US
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Telephone | 407-751-2192
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Fax |
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Provider Business Mailing Address
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Address Line | 6518 CICERO LN
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City | ORLANDO
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State | FL
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Zip | 32809-5911
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Country | US
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Telephone | 407-288-3371
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. HERIBERTO LUIS 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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 48-641825503
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License Number State | FL
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