Healthcare Provider Details

I. General information

NPI: 1619009925
Provider Name (Legal Business Name): MONA ISSA CHIROPRACTIC AND HOLISTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LINCOLN RD #102
MIAMI BEACH FL
33139-2879
US

IV. Provider business mailing address

701 LINCOLN RD #102
MIAMI BEACH FL
33139-2879
US

V. Phone/Fax

Practice location:
  • Phone: 305-538-5448
  • Fax:
Mailing address:
  • Phone: 305-538-5448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8219
License Number StateFL

VIII. Authorized Official

Name: DR. MONA ISSA
Title or Position: DIRECTOR
Credential: D.C., P.A.
Phone: 305-538-5448