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General NPI Number Information
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NPI Number | 1063446755
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Entity Type | Organization
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Legal Business Name | HEALING EARTH & REJUVENATION
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18205 BISCAYNE BLVD #100
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City | AVENTURA
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State | FL
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Zip | 33160-2106
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Country | US
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Telephone | 305-792-0007
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Fax | 305-792-0990
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Provider Business Mailing Address
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Address Line | 18205 BISCAYNE BLVD #100
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City | AVENTURA
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State | FL
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Zip | 33160-2106
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Country | US
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Telephone | 305-792-0007
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Fax | 305-792-0990
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. MARK G. ASTOR
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Credential |
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Telephone | 305-792-0007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME86974
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License Number State | WI
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