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General NPI Number Information
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NPI Number | 1396163952
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Entity Type | Organization
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Legal Business Name | NEUROPLACE P.A.
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | 6290 BETTY AVE
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City | COCOA
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State | FL
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Zip | 32927-4202
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Country | US
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Telephone | 321-301-4299
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Fax | 321-301-4299
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Provider Business Mailing Address
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Address Line | 6290 BETTY AVE
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City | COCOA
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State | FL
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Zip | 32927-4202
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Country | US
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Telephone | 321-301-4299
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Fax | 321-301-4299
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VESNA MICIC
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Credential | M.D.
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Telephone | 832-370-3789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME104201
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License Number State | FL
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