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General NPI Number Information
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NPI Number | 1104148477
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Entity Type | Organization
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Legal Business Name | ACHE-FREE BODY, INC.
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 4343 W FLAGLER ST SUITE 506
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City | CORAL GABLES
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State | FL
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Zip | 33134-1586
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Country | US
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Telephone | 305-446-7898
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Fax | 305-446-7897
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Provider Business Mailing Address
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Address Line | 4343 W FLAGLER ST SUITE 506
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City | CORAL GABLES
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State | FL
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Zip | 33134-1586
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Country | US
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Telephone | 305-446-7898
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Fax | 305-446-7897
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEAN A YAQUE
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Credential |
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Telephone | 305-446-7898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | MM 24375
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License Number State | FL
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