Healthcare Provider Details

I. General information

NPI: 1215057294
Provider Name (Legal Business Name): LANDON I AGOADO A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 N UNIVERSITY DR #103
TAMARAC FL
33321-2115
US

IV. Provider business mailing address

260 NE 3RD ST #D
DELRAY BEACH FL
33444-3738
US

V. Phone/Fax

Practice location:
  • Phone: 954-752-8888
  • Fax: 954-721-8843
Mailing address:
  • Phone: 954-260-2626
  • Fax: 954-721-8843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP1704
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: