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General NPI Number Information
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NPI Number | 1912453531
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL ASSOCIATES LLC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 225 W SR 434
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City | LONGWOOD
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State | FL
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Zip | 32750-4980
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Country | US
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Telephone | 407-608-5638
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Fax | 407-608-5639
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Provider Business Mailing Address
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Address Line | 225 W SR 434
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City | LONGWOOD
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State | FL
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Zip | 32750-4980
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Country | US
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Telephone | 407-608-5638
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Fax | 407-608-5639
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Authorized Official
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Title or Position | OWNER
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Name | MARC OTT
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Credential |
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Telephone | 407-488-3751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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