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General NPI Number Information
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NPI Number | 1912348582
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE BIOREGULATORY MEDICINE, LLC
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Dates
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Enumeration Date | 07/11/2013
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 7480 FAIRWAY DR SUITE 108
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6879
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Country | US
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Telephone | 786-284-0117
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Fax |
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Provider Business Mailing Address
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Address Line | 7480 FAIRWAY DR SUITE 108
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City | MIAMI LAKES
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State | FL
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Zip | 33014-6879
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Country | US
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Telephone | 786-284-0117
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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. CELESTINO LOPEZ
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Credential | AP
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Telephone | 786-284-0117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP355
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License Number State | FL
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