Healthcare Provider Details

I. General information

NPI: 1356567416
Provider Name (Legal Business Name): DAO QUN LUO C.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 W STATE ROAD 436 STE 1039
ALTAMONTE SPRINGS FL
32714-3041
US

IV. Provider business mailing address

851 W STATE ROAD 436 STE 1039
ALTAMONTE SPRINGS FL
32714-3041
US

V. Phone/Fax

Practice location:
  • Phone: 407-788-2668
  • Fax: 407-788-2668
Mailing address:
  • Phone: 407-788-2668
  • Fax: 407-788-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: