Healthcare Provider Details

I. General information

NPI: 1275959801
Provider Name (Legal Business Name): EASTERN ACUPUNCTURE AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13224 W BROWARD BLVD
PLANTATION FL
33325-2228
US

IV. Provider business mailing address

13224 W BROWARD BLVD
PLANTATION FL
33325-2228
US

V. Phone/Fax

Practice location:
  • Phone: 954-400-5504
  • Fax: 954-400-5503
Mailing address:
  • Phone: 954-400-5504
  • Fax: 954-400-5504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3349
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA51421
License Number StateFL

VIII. Authorized Official

Name: JENNIFER CRUZ
Title or Position: OWNER, ACUPUNCTURIST
Credential: AP
Phone: 954-400-5504