Provider Demographics
NPI:1003498163
Name:INTEGRATED HEALTHPROMOTION
Entity type:Organization
Organization Name:INTEGRATED HEALTHPROMOTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATYA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:RIDORE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:914-340-3084
Mailing Address - Street 1:1320 ORTEGA ST
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4807
Mailing Address - Country:US
Mailing Address - Phone:914-340-3084
Mailing Address - Fax:
Practice Address - Street 1:118 W STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-2551
Practice Address - Country:US
Practice Address - Phone:914-340-3084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOQ279OtherHF MEDICARE
FL112849800Medicaid