Healthcare Provider Details

I. General information

NPI: 1063674687
Provider Name (Legal Business Name): MIAMI ORIENTAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 GIRALDA AVE
CORAL GABLES FL
33134-5208
US

IV. Provider business mailing address

195 GIRALDA AVE
CORAL GABLES FL
33134-5208
US

V. Phone/Fax

Practice location:
  • Phone: 305-567-1973
  • Fax: 305-567-1974
Mailing address:
  • Phone: 305-567-1973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1850
License Number StateFL

VIII. Authorized Official

Name: LISSA H. NIRENBERG
Title or Position: OWNER
Credential: DOM
Phone: 305-567-1973