Healthcare Provider Details

I. General information

NPI: 1508000258
Provider Name (Legal Business Name): CARING ACUPUNCTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 WOODED CROSSING CIR
SAINT AUGUSTINE FL
32084-6546
US

IV. Provider business mailing address

490 WOODED CROSSING CIR
SAINT AUGUSTINE FL
32084-6546
US

V. Phone/Fax

Practice location:
  • Phone: 321-298-6182
  • Fax:
Mailing address:
  • Phone: 321-298-6182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 2652
License Number StateFL

VIII. Authorized Official

Name: MISS KALMA ROSE GRAHAM
Title or Position: ACUPUNCTURE PHYSICIAN
Credential: AP
Phone: 321-298-6182