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General NPI Number Information
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NPI Number | 1295276756
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Entity Type | Organization
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Legal Business Name | ETERNAL ACUPUNCTURE LLC
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 2061 NW 2ND AVE SUITE 208
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City | BOCA RATON
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State | FL
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Zip | 33431-6776
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Country | US
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Telephone | 561-706-2642
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Fax |
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Provider Business Mailing Address
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Address Line | 2825 N CLEARBROOK CIR
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City | DELRAY BEACH
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State | FL
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Zip | 33445-4564
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Country | US
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Telephone | 561-452-6645
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KORNELIA ANNA VITEZ
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Credential | L.AC., DIPL.O.M.
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Telephone | 561-706-2642
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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 | AP3755
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License Number State | FL
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