Healthcare Provider Details

I. General information

NPI: 1891077673
Provider Name (Legal Business Name): OASIS MEDICAL ACUHEALING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W OAK RIDGE RD SUITE B
ORLANDO FL
32809-4765
US

IV. Provider business mailing address

1011 W OAK RIDGE RD SUITE B
ORLANDO FL
32809-4765
US

V. Phone/Fax

Practice location:
  • Phone: 407-888-8411
  • Fax: 407-888-8371
Mailing address:
  • Phone: 407-888-8411
  • Fax: 407-888-8371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME60805
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2122
License Number StateFL

VIII. Authorized Official

Name: CORA C HUTCHINSON-MOODY
Title or Position: BILLING MANAGER
Credential: BA
Phone: 954-695-9620