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General NPI Number Information
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NPI Number | 1104234202
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Entity Type | Organization
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Legal Business Name | BLOSSOM ACUPUNCTURE LLC
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Dates
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Enumeration Date | 08/01/2014
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Last Update Date | 08/01/2014
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Provider Practice Location Address
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Address Line | 8353 SW 124TH ST SUITE 201
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City | MIAMI
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State | FL
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Zip | 33156-5851
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Country | US
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Telephone | 305-878-9012
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Fax |
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Provider Business Mailing Address
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Address Line | 15420 SW 78TH CT
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City | PALMETTO BAY
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State | FL
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Zip | 33157-2348
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Country | US
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Telephone | 305-878-9012
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IGNACIO MENDEZ
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Credential | AP
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Telephone | 305-878-9012
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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 | 3320
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License Number State | FL
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