| NPI | 1316165764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVIS FONSECA Billing Manager 305-292-3600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: FL ME88361) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |