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General NPI Number Information
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NPI Number | 1326321134
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE ACUPUNCTURE WELLNESS CENTER AND SPA
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 3504 GRAYCLIFF LN
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City | BRANDON
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State | FL
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Zip | 33511-7856
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Country | US
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Telephone | 813-528-0870
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Fax |
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Provider Business Mailing Address
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Address Line | 3504 GRAYCLIFF LN
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City | BRANDON
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State | FL
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Zip | 33511-7856
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SU HO
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Credential |
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Telephone | 813-528-0870
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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 | AP2153
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License Number State | FL
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