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General NPI Number Information
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NPI Number | 1205370848
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Entity Type | Organization
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Legal Business Name | MEDICA VITA LLC
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 710 W PRINCETON ST SUITE A
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City | ORLANDO
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State | FL
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Zip | 32804-5214
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Country | US
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Telephone | 407-936-4238
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Fax |
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Provider Business Mailing Address
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Address Line | 5357 BAMBOO CT
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City | ORLANDO
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State | FL
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Zip | 32811-6723
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Country | US
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Telephone | 407-936-4238
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ANDRIY CHETIN
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Credential | AP
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Telephone | 407-936-4238
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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 | 3700
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License Number State | FL
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