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General NPI Number Information
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NPI Number | 1184190753
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Entity Type | Organization
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Legal Business Name | BEAUTIFUL MIND CLINIC, LLC
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 7208 W SAND LAKE RD STE 305
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City | ORLANDO
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State | FL
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Zip | 32819-5279
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Country | US
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Telephone | 407-799-8808
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Fax | 407-440-4307
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Provider Business Mailing Address
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Address Line | 7208 W SAND LAKE RD STE 305
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City | ORLANDO
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State | FL
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Zip | 32819-5279
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Country | US
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Telephone | 407-799-8808
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Fax |
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Authorized Official
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Title or Position | HEALTHCARE ADMINISTRATOR
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Name | MR. DAMON LAI
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Credential |
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Telephone | 407-799-8808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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