Provider Demographics
NPI:1457994261
Name:INTELLIHEALTH MEDICAL
Entity Type:Organization
Organization Name:INTELLIHEALTH MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESTEFANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-684-7024
Mailing Address - Street 1:3280 TAMIAMI TRL # 55A-294
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8053
Mailing Address - Country:US
Mailing Address - Phone:323-684-7024
Mailing Address - Fax:
Practice Address - Street 1:3280 TAMIAMI TRL # 55A-294
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8053
Practice Address - Country:US
Practice Address - Phone:323-684-7024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty