Provider Demographics
NPI:1336293539
Name:INTERNAL MEDICINE ASSOCIATES & SPECIALTIES,INC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES & SPECIALTIES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:FAUSTO
Authorized Official - Middle Name:
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-450-8488
Mailing Address - Street 1:603 N FLAMINGO RD STE 357
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1013
Mailing Address - Country:US
Mailing Address - Phone:954-450-8488
Mailing Address - Fax:
Practice Address - Street 1:603 N FLAMINGO RD STE 357
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1013
Practice Address - Country:US
Practice Address - Phone:954-450-8488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048782207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115790700Medicaid