Provider Demographics
NPI:1073179396
Name:KETAMINE HEALTH CENTERS OF WEST PALM BEACH, LLC
Entity Type:Organization
Organization Name:KETAMINE HEALTH CENTERS OF WEST PALM BEACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-793-4855
Mailing Address - Street 1:5745 SW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6317
Mailing Address - Country:US
Mailing Address - Phone:305-793-4855
Mailing Address - Fax:
Practice Address - Street 1:1411 N FLAGLER DR STE 9000
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3421
Practice Address - Country:US
Practice Address - Phone:561-766-0818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center