Healthcare Provider Details

I. General information

NPI: 1437708799
Provider Name (Legal Business Name): FTX MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7815 NW BEACON SQUARE BLVD STE 201
BOCA RATON FL
33487-1345
US

IV. Provider business mailing address

7815 NW BEACON SQUARE BLVD STE 201
BOCA RATON FL
33487-1345
US

V. Phone/Fax

Practice location:
  • Phone: 561-995-0136
  • Fax:
Mailing address:
  • Phone: 561-995-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: OCTAVIO CIFUENTES
Title or Position: OWNER
Credential:
Phone: 561-995-0136