Healthcare Provider Details

I. General information

NPI: 1427431394
Provider Name (Legal Business Name): XTREME HEALING & ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 NE 3RD AVE UNIT 1
FORT LAUDERDALE FL
33305-2905
US

IV. Provider business mailing address

2787 E OAKLAND PARK BLVD STE 208
FORT LAUDERDALE FL
33306-1643
US

V. Phone/Fax

Practice location:
  • Phone: 954-297-8196
  • Fax:
Mailing address:
  • Phone: 954-297-8196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberAP3042
License Number StateFL

VIII. Authorized Official

Name: FRANTZ DUCLERVIL
Title or Position: ACUPUNCTURIST, AP, LAC
Credential: AP, LAC
Phone: 954-297-8196