Healthcare Provider Details

I. General information

NPI: 1861696957
Provider Name (Legal Business Name): SAINLOUITANE THEUS D.O.M
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ORANGE AVE
FORT PIERCE FL
34947-3607
US

IV. Provider business mailing address

3513 PALAIS TER
WELLINGTON FL
33467-8063
US

V. Phone/Fax

Practice location:
  • Phone: 561-302-7402
  • Fax: 954-429-1063
Mailing address:
  • Phone: 561-302-7402
  • Fax: 954-429-1063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 2293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: