Provider Demographics
NPI:1659831261
Name:THERAPEUTIC INTEGRATED MEDICAL CARE INC
Entity Type:Organization
Organization Name:THERAPEUTIC INTEGRATED MEDICAL CARE INC
Other - Org Name:TIM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-303-8108
Mailing Address - Street 1:PO BOX 71526
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89170-1526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:916 W OWENS AVE STE D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2516
Practice Address - Country:US
Practice Address - Phone:702-617-6313
Practice Address - Fax:702-901-7224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERAPEUTIC INTEGRATED MEDICAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-20
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1770085755Medicaid
NV1740770643Medicaid