Healthcare Provider Details

I. General information

NPI: 1699644575
Provider Name (Legal Business Name): MIA ANGELA DEQUINE AP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 12TH ST # 12
MIAMI BEACH FL
33139-4500
US

IV. Provider business mailing address

507 12TH ST # 12
MIAMI BEACH FL
33139-4500
US

V. Phone/Fax

Practice location:
  • Phone: 305-610-2299
  • Fax:
Mailing address:
  • Phone: 305-610-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: