Provider Demographics
NPI:1528332814
Name:ADVANCED INTEGRATIVE CARE
Entity type:Organization
Organization Name:ADVANCED INTEGRATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAEDAE
Authorized Official - Suffix:
Authorized Official - Credentials:OMD
Authorized Official - Phone:863-414-4173
Mailing Address - Street 1:7450 DR PHILLIPS BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5120
Mailing Address - Country:US
Mailing Address - Phone:863-414-4173
Mailing Address - Fax:
Practice Address - Street 1:7450 DR PHILLIPS BLVD STE 203
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5120
Practice Address - Country:US
Practice Address - Phone:863-414-4173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-04
Last Update Date:2012-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3075171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty