Provider Demographics
NPI:1598300741
Name:CENTER FOR INTEGRATIVE & FUNCTIONAL ENDOCRINOLOGY LLC
Entity Type:Organization
Organization Name:CENTER FOR INTEGRATIVE & FUNCTIONAL ENDOCRINOLOGY LLC
Other - Org Name:VITRA GOSINE
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VITRA
Authorized Official - Middle Name:NISHI
Authorized Official - Last Name:GOSINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-800-1408
Mailing Address - Street 1:17900 NW 5TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2809
Mailing Address - Country:US
Mailing Address - Phone:954-800-1408
Mailing Address - Fax:954-842-4966
Practice Address - Street 1:17900 NW 5TH ST STE 202
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2809
Practice Address - Country:US
Practice Address - Phone:954-800-1408
Practice Address - Fax:954-842-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty