=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265812705
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPIRAHEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2015
-----------------------------------------------------
Last Update Date | 05/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4302 ALTON RD STE 470 #606
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-2842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-978-1033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1835 E HALLANDALE BEACH BLVD #606
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-978-1033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF ORIENTAL MEDICINE
-----------------------------------------------------
Name | DR. HOLLY NOBIL
-----------------------------------------------------
Credential | D.O.M
-----------------------------------------------------
Telephone | 305-978-1033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305S00000X
-----------------------------------------------------
Taxonomy Name | Point of Service
-----------------------------------------------------
License Number | AP3347
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------