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General NPI Number Information
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NPI Number | 1467857169
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Entity Type | Organization
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Legal Business Name | PINECREST ACUPUNCTURE INC
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 9300 S DIXIE HWY STE 106
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City | MIAMI
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State | FL
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Zip | 33156-2935
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Country | US
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Telephone | 305-670-6696
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Fax |
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Provider Business Mailing Address
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Address Line | 9300 S DIXIE HWY STE 106
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City | MIAMI
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State | FL
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Zip | 33156-2935
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Country | US
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Telephone | 305-670-6696
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL ERIC COSTA
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Credential | L.AC.
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Telephone | 305-670-6696
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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 | AP3512
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License Number State | FL
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