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General NPI Number Information
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NPI Number | 1225884232
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Entity Type | Organization
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Legal Business Name | MEDMAX ACUPUNCTURE LLC
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Dates
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Enumeration Date | 04/29/2024
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 12781 MIRAMAR PKWY STE 206
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City | MIRAMAR
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State | FL
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Zip | 33027-2908
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Country | US
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Telephone | 786-907-5827
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Fax | 954-272-7179
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Provider Business Mailing Address
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Address Line | 5197 SW 19TH ST
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City | WEST PARK
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State | FL
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Zip | 33023-3272
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Country | US
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Telephone | 786-907-5827
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Fax | 954-272-7179
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MRS. BETTY LARA-CORMIER
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Credential | AP
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Telephone | 954-588-7999
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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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