Healthcare Provider Details

I. General information

NPI: 1790219905
Provider Name (Legal Business Name): FIFTH PIVOT ACUPUNCTURE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16650 N KENDALL DR STE 201
MIAMI FL
33196-1280
US

IV. Provider business mailing address

16650 N KENDALL DR STE 201
MIAMI FL
33196-1280
US

V. Phone/Fax

Practice location:
  • Phone: 786-863-7088
  • Fax:
Mailing address:
  • Phone: 786-863-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3650
License Number StateFL

VIII. Authorized Official

Name: JESSICA LYNN DEL VALLE
Title or Position: CEO
Credential: L.AC.
Phone: 786-863-7088