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General NPI Number Information
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NPI Number | 1790184240
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Entity Type | Organization
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Legal Business Name | ADVANCED INTEGRATIVE MEDICINE & ASSOCIATES, LLC
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Dates
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Enumeration Date | 08/21/2014
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 800 E CYPRESS CREEK RD SUITE 203
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City | FT LAUDERDALE
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State | FL
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Zip | 33334-3522
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Country | US
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Telephone | 954-870-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 800 E CYPRESS CREEK RD SUITE 203
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City | FT LAUDERDALE
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State | FL
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Zip | 33334-3522
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Country | US
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Telephone | 954-870-7878
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LAZARO PEREZ
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Credential |
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Telephone | 954-870-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | FL
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