Provider Demographics
NPI:1003498163
Name:INTEGRATED HEALTHPROMOTION
Entity Type:Organization
Organization Name:INTEGRATED HEALTHPROMOTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATYA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:RIDORE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:914-340-3084
Mailing Address - Street 1:315 S RONALD REAGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5404
Mailing Address - Country:US
Mailing Address - Phone:407-637-5656
Mailing Address - Fax:407-637-5725
Practice Address - Street 1:315 S RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5404
Practice Address - Country:US
Practice Address - Phone:407-637-5656
Practice Address - Fax:407-637-5725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOQ279OtherHF MEDICARE