Healthcare Provider Details

I. General information

NPI: 1922168509
Provider Name (Legal Business Name): ACUPUNCTURE & ORIENTAL MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 AVENUE C NE
WINTER HAVEN FL
33881-4558
US

IV. Provider business mailing address

306 AVENUE C NE
WINTER HAVEN FL
33881-4558
US

V. Phone/Fax

Practice location:
  • Phone: 863-401-3606
  • Fax: 863-291-4256
Mailing address:
  • Phone: 863-401-3606
  • Fax: 863-291-4256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNE MARIE DAZET
Title or Position: LICENSED ACUPUNCTURIST
Credential: LAC
Phone: 863-401-3606