Healthcare Provider Details

I. General information

NPI: 1316903578
Provider Name (Legal Business Name): ADA Y KNECHT DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 GIRALDA AVE
CORAL GABLES FL
33134-5208
US

IV. Provider business mailing address

14075 SW 72ND CT
PALMETTO BAY FL
33158-1263
US

V. Phone/Fax

Practice location:
  • Phone: 305-567-1973
  • Fax:
Mailing address:
  • Phone: 305-342-0076
  • Fax: 305-378-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP1761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: