Provider Demographics
NPI:1730715897
Name:INTEGRATED PRIMARY CARE & PSYCH MENTAL HEALTH LLC
Entity type:Organization
Organization Name:INTEGRATED PRIMARY CARE & PSYCH MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:AQUINO-MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-667-4186
Mailing Address - Street 1:4300 N UNIVERSITY DR STE C103
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6243
Mailing Address - Country:US
Mailing Address - Phone:954-478-5763
Mailing Address - Fax:954-901-2713
Practice Address - Street 1:4300 N UNIVERSITY DR STE C103
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6243
Practice Address - Country:US
Practice Address - Phone:954-478-5763
Practice Address - Fax:954-901-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1376918631OtherNPI