Healthcare Provider Details

I. General information

NPI: 1194049593
Provider Name (Legal Business Name): ACUPUNCTURE HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BLACKWOOD AVE STE 110
OCOEE FL
34761-4519
US

IV. Provider business mailing address

1151 BLACKWOOD AVE STE 110
OCOEE FL
34761-4519
US

V. Phone/Fax

Practice location:
  • Phone: 321-662-2632
  • Fax:
Mailing address:
  • Phone: 321-662-2632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 2794
License Number StateFL

VIII. Authorized Official

Name: MEHRAFROUZ FORADI
Title or Position: PRESIDENT
Credential: A.P.
Phone: 321-662-2632