Provider Demographics
NPI:1396100343
Name:INTEGRATIVE HEALTH CARE INSTITUTE LLC
Entity type:Organization
Organization Name:INTEGRATIVE HEALTH CARE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:MBR
Authorized Official - Phone:305-443-3480
Mailing Address - Street 1:3211 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-7274
Mailing Address - Country:US
Mailing Address - Phone:305-443-3480
Mailing Address - Fax:
Practice Address - Street 1:3211 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE #102
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-7274
Practice Address - Country:US
Practice Address - Phone:305-443-3480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14000181260171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty