Healthcare Provider Details

I. General information

NPI: 1740668029
Provider Name (Legal Business Name): DEBRA MACE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15357 76TH TRL N
WEST PALM BEACH FL
33418-7316
US

IV. Provider business mailing address

15357 76TH TRL N
WEST PALM BEACH FL
33418-7316
US

V. Phone/Fax

Practice location:
  • Phone: 561-351-6225
  • Fax:
Mailing address:
  • Phone: 561-351-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberMA40066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: