Healthcare Provider Details

I. General information

NPI: 1629704697
Provider Name (Legal Business Name): CUPPED CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 N CENTRO CIR # A
SHENANDOAH TX
77385-5611
US

IV. Provider business mailing address

385 N CENTRO CIR # A
SHENANDOAH TX
77385-5611
US

V. Phone/Fax

Practice location:
  • Phone: 214-980-4687
  • Fax:
Mailing address:
  • Phone: 936-266-0262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE ZAMORA
Title or Position: OWNER
Credential:
Phone: 936-226-0262