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NPI Code Detail

MEDICARE: LIVING WATERS WELLNESS CENTER INC

MEDICARE: LIVING WATERS WELLNESS CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturistAP 2758FL

General Provider Information

NPI Number : 1043536824
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIVING WATERS WELLNESS CENTER INC
Provider Business Mailing Address
First Line : 5840 S SEMORAN BLVD STE B
Second Line :
City : ORLANDO
State : FL
Zip : 32822-4808
Country : US
Telephone Number : 407-580-5768
Fax Number :
Provider Business Practice Location Address
First Line : 5840 S SEMORAN BLVD STE B
Second Line :
City : ORLANDO
State : FL
Zip : 32822-4808
Country : US
Telephone Number : 407-580-5768
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : IVETTE MARTINEZ
Credential : A.P.
Telephone Number : 407-580-5768
Provider Enumeration Date : 04/19/2010
Last Update Date : 04/19/2010

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Directions to “LIVING WATERS WELLNESS CENTER INC ” Practice Location

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