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General NPI Number Information
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NPI Number | 1003178047
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Entity Type | Organization
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Legal Business Name | MIA ACUPUNCTURE, LLC
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 1100 E HALLANDALE BEACH BLVD
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4432
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Country | US
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Telephone | 954-456-6945
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Fax |
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Provider Business Mailing Address
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Address Line | 9801 COLLINS AVE APT 14I
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City | BAL HARBOUR
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State | FL
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Zip | 33154-1840
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Country | US
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Telephone | 305-606-8901
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURE PHYSICIAN AND OWNER
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Name | MRS. DANIELLE RACHEL KASSIN
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Credential | LAP, DOM
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Telephone | 305-606-8901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP2904
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License Number State | FL
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