Healthcare Provider Details

I. General information

NPI: 1154659944
Provider Name (Legal Business Name): JOSEPH PRICE DESTINOBLES AP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18752 SW 27 STREET
MIRAMAR FL
33029
US

IV. Provider business mailing address

12944 W DIXIE HWY
NORTH MIAMI FL
33161-4810
US

V. Phone/Fax

Practice location:
  • Phone: 305-895-4900
  • Fax:
Mailing address:
  • Phone: 305-895-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: