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General NPI Number Information
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NPI Number | 1225455561
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Entity Type | Organization
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Legal Business Name | NAMASTE HOLISTIC CENTER, CORP
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 18503 PINES BLVD SUITE 309
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1404
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Country | US
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Telephone | 954-885-5279
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Fax |
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Provider Business Mailing Address
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Address Line | 2103 RENAISSANCE BLVD APT 201
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City | MIRAMAR
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State | FL
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Zip | 33025-5691
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Country | US
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Telephone | 954-200-4587
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF ORIENTAL MEDICINE
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Name | DR. SANDRA MORA-VIERA
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Credential | DOM, MD (COLOMBIA)
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Telephone | 954-200-4587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | AP2891
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License Number State | FL
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