Healthcare Provider Details

I. General information

NPI: 1609132703
Provider Name (Legal Business Name): CLASSICAL HERBS AND ACUPUNCTURE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9655 S DIXIE HWY SUITE 204
PINECREST FL
33156-2813
US

IV. Provider business mailing address

9655 S DIXIE HWY SUITE 204
PINECREST FL
33156-2813
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-9711
  • Fax:
Mailing address:
  • Phone: 305-665-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAP974
License Number StateFL

VIII. Authorized Official

Name: CAROLYN COOK
Title or Position: OWNER
Credential: AP
Phone: 305-665-9711