Healthcare Provider Details

I. General information

NPI: 1457550097
Provider Name (Legal Business Name): JEFFREY ALAN PROL L AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 W 41ST ST SUITE: 500
MIAMI BEACH FL
33140-3329
US

IV. Provider business mailing address

975 W 41ST ST SUITE: 500
MIAMI BEACH FL
33140-3329
US

V. Phone/Fax

Practice location:
  • Phone: 305-532-0777
  • Fax: 305-532-0888
Mailing address:
  • Phone: 305-532-0777
  • Fax: 305-532-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 2434
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: