Organization
ENLIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVI BIFSHA DC (OWNER)
(321) 947-5618
Entity
Organization
Contact information
Practice address
4871 NEW BROAD ST, ORLANDO, FL 32814-6629
(321) 947-5618
Mailing address
4871 NEW BROAD ST, ORLANDO, FL 32814-6629
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
02/27/2019
Last updated
02/27/2019
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