Healthcare Provider Details

I. General information

NPI: 1174244198
Provider Name (Legal Business Name): WHOLISTIC HEALTH MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 WEST RD STE A
OCOEE FL
34761-5300
US

IV. Provider business mailing address

438 ALSTON DR
ORLANDO FL
32835-6024
US

V. Phone/Fax

Practice location:
  • Phone: 407-630-7525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: QUOC HUYNH
Title or Position: ACUPUNCTURIST
Credential: AP
Phone: 407-575-1355