KETAMINE HEALTH CENTERS AT BONITA SPRINGS LLC NPI 1518587245

NPI Information

KETAMINE HEALTH CENTERS AT BONITA SPRINGS, LLC is a health service clinic center in Bonita Springs, FL. KETAMINE HEALTH CENTERS AT BONITA SPRINGS, LLC NPI is 1518587245. The provider is registered as an organization entity type.
The provider Is Doing Business As Ketamine Health Centers.

The provider's business location address is:

26800 S TAMIAMI TRL STE 310
BONITA SPRINGS, FL
ZIP 34134-348
Phone: (305) 856-9442

The provider's authorized official is Raul A Cruz .
The authorized official title is Owner and has the following contact phone number (305) 856-9442.

The CLIA number assigned to this NPI record is 10D2208352 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/22/2020 and was last updated on 7/21/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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