Provider Demographics
NPI:1770967663
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:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
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:305-443-3478
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:305-443-3478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty