MEDICARE: UNIFIED EARTH MEDICINE

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
1	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1851976823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIFIED EARTH MEDICINE

Provider Business Mailing Address
First Line	:	1825 NE 26TH AVE APT 2
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305-3560
Country	:	US
Telephone Number	:	954-405-0779
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 NE 26TH AVE APT 2
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305-3560
Country	:	US
Telephone Number	:	954-405-0779
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RICARDO VILLALBA
Credential	:	LAC
Telephone Number	:	954-405-0779

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	03/11/2021

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Directions to “UNIFIED EARTH MEDICINE ” Practice Location

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