Healthcare Provider Details

I. General information

NPI: 1053612085
Provider Name (Legal Business Name): ACUPUNCTURE CENTER FOR WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16666 NE 19TH AVE STE 111
NORTH MIAMI BEACH FL
33162-3158
US

IV. Provider business mailing address

16666 NE 19TH AVE STE 111
NORTH MIAMI BEACH FL
33162-3158
US

V. Phone/Fax

Practice location:
  • Phone: 305-940-7763
  • Fax: 305-940-0059
Mailing address:
  • Phone: 305-940-7763
  • Fax: 305-940-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberMM23356
License Number StateFL

VIII. Authorized Official

Name: MRS. ROXANA M GONZALEZ-POUZA
Title or Position: PRESIDENT
Credential: AP
Phone: 305-940-7763