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General NPI Number Information
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NPI Number | 1144705690
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Entity Type | Organization
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Legal Business Name | BLUE ORCHID ACUPUNCTURE AND TRADITIONAL HERB CLINIC LLC
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 2105 HARTWOOD MARSH RD STE 9
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City | CLERMONT
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State | FL
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Zip | 34711-5390
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Country | US
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Telephone | 352-988-5697
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Fax |
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Provider Business Mailing Address
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Address Line | 10616 WHITMAN CIR
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City | ORLANDO
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State | FL
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Zip | 32821-8619
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Country | US
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Telephone | 407-590-5945
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | QIANQIAN LIN
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Credential | AP
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Telephone | 407-590-5945
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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 |
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License Number State |
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