Provider Demographics
NPI:1871615682
Name:INTEGRATIVE HEALTH CENTER
Entity type:Organization
Organization Name:INTEGRATIVE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:ALTAGRACIA
Authorized Official - Last Name:FERREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-559-7063
Mailing Address - Street 1:13155 SW 42ND STREET
Mailing Address - Street 2:SUIT 111 112
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3428
Mailing Address - Country:US
Mailing Address - Phone:305-559-7063
Mailing Address - Fax:305-559-7839
Practice Address - Street 1:13155 SW 42ND STREET
Practice Address - Street 2:SUIT 111 112
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3428
Practice Address - Country:US
Practice Address - Phone:305-559-7063
Practice Address - Fax:305-559-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57254208000000X
208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009723000Medicaid
FL051410100Medicaid
FL009723000Medicaid
FL051410100Medicaid