Ketamine Health Centers at Bonita Springs, LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

KETAMINE HEALTH CENTERS AT BONITA SPRINGS, LLC

Doing business as

Ketamine Health Centers

Practice address

26800 S Tamiami TRL Ste 310
Bonita Springs, FL 34134-4348

Phone

(305) 856-9442

NPI assigned

Apr 22, 2020

Last updated

Jul 31, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Raul A Cruz, MD

Title

Owner

Phone

(305) 856-9442

Specialties & licenses 1

Addresses

Other names 1

• Ketamine Health Centers Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1518587245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 S DIXIE HWY STE 204",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "331463127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26800 S TAMIAMI TRL STE 310",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341344348",
            "telephone_number": "305-856-9442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE HEALTH CENTERS AT BONITA SPRINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-22",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A",
        "authorized_official_last_name": "CRUZ",
        "authorized_official_first_name": "RAUL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-856-9442",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ketamine Health Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ketamine Health Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Health Service Clinic/Center in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• Health Service Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.