Healthcare Provider Details

I. General information

NPI: 1871069146
Provider Name (Legal Business Name): HUMBLE BUDDHA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 NE 33RD ST
FORT LAUDERDALE FL
33308-7109
US

IV. Provider business mailing address

3305 NE 33RD ST
FORT LAUDERDALE FL
33308-7109
US

V. Phone/Fax

Practice location:
  • Phone: 954-909-4923
  • Fax:
Mailing address:
  • Phone: 954-909-4923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISTY DAVIS
Title or Position: OWNER
Credential:
Phone: 954-909-4923