Healthcare Provider Details

I. General information

NPI: 1720345226
Provider Name (Legal Business Name): DIVYA MARIE COMEAU A.P., D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA MARIE COMEAU

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CRAWFORD BLVD SUITE 103
BOCA RATON FL
33432-3777
US

IV. Provider business mailing address

301 CRAWFORD BLVD SUITE 103
BOCA RATON FL
33432-3777
US

V. Phone/Fax

Practice location:
  • Phone: 561-703-7830
  • Fax:
Mailing address:
  • Phone: 561-703-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2971
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: