MEDICARE: I AM EQUILIBRIUM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932777356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I AM EQUILIBRIUM LLC

Provider Business Mailing Address
First Line	:	6463 BIRD RD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-4827
Country	:	US
Telephone Number	:	305-790-6125
Fax Number	:

Provider Business Practice Location Address
First Line	:	6463 BIRD RD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-4827
Country	:	US
Telephone Number	:	305-790-6125
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	IVETTE AGUSTI
Credential	:
Telephone Number	:	786-543-1377

Provider Enumeration Date	:	06/13/2021
Last Update Date	:	01/26/2022

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Directions to “I AM EQUILIBRIUM LLC ” Practice Location

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