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General NPI Number Information
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NPI Number | 1063740678
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Entity Type | Individual
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Provider Name | HADIJAH VANADA EGGLETON L.AC.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2009
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Last Update Date | 11/20/2009
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Provider Practice Location Address
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Address Line | 3939 HOLLYWOOD BLVD MEDICAL RESEARCH CENTER: AL NISA CLINIC 3RD FLOOR
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6749
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Country | US
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Telephone | 954-272-6011
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Fax | 954-272-6012
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Provider Business Mailing Address
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Address Line | 3939 HOLLYWOOD BLVD MEDICAL RESEARCH CENTER: AL NISA CLINIC 3RD FLOOR
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6749
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Country | US
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Telephone | 954-272-6011
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Fax | 954-272-6012
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2589
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License Number State | FL
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