Integrated Mind Medicine

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME121955 Issued in FL

Legal business name

INTEGRATED MIND MEDICINE

Practice address

1946 Tyler St
Suite 14
Hollywood, FL 33020-4517

Phone

(754) 210-5359

Fax

(754) 210-5363

NPI assigned

Apr 8, 2015

Organization subpart

No

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

Authorized official

Name

Mencia Gomez

Title

MD

Phone

(754) 210-5359

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1428451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428451200000",
    "number": "1730575549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1946 TYLER ST",
            "address_2": "SUITE 14",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330204517",
            "telephone_number": "754-210-5359",
            "fax_number": "754-210-5363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1946 TYLER ST",
            "address_2": "SUITE 14",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330204517",
            "telephone_number": "754-210-5359",
            "fax_number": "754-210-5363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED MIND MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-08",
        "last_updated": "2015-04-08",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "MENCIA",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "754-210-5359"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME121955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2015; 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.