Provider Demographics
NPI:1477829398
Name:INTEGRATED HOLISTIC MEDICINE
Entity Type:Organization
Organization Name:INTEGRATED HOLISTIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:RESTREPO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:954-825-3670
Mailing Address - Street 1:9045 LA FONTANA BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5636
Mailing Address - Country:US
Mailing Address - Phone:954-825-3670
Mailing Address - Fax:
Practice Address - Street 1:9045 LA FONTANA BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-5636
Practice Address - Country:US
Practice Address - Phone:954-825-3670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-25
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3080171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty