Provider Demographics
NPI:1528633047
Name:DRFICO INTEGRATIVE MEDICINE AND FUNCTIONAL GASTROENTEROLOGY CENTER
Entity type:Organization
Organization Name:DRFICO INTEGRATIVE MEDICINE AND FUNCTIONAL GASTROENTEROLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAUTISTA-MENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-964-2817
Mailing Address - Street 1:8350 SW 131ST ST
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-6656
Mailing Address - Country:US
Mailing Address - Phone:347-964-2817
Mailing Address - Fax:
Practice Address - Street 1:7100 W 20TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1813
Practice Address - Country:US
Practice Address - Phone:347-964-2817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty