=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487192431
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERFECT BLEND ACUPUNCTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2017
-----------------------------------------------------
Last Update Date | 02/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1905 BAYWOOD DR
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34231-4716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-321-7171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4235 LANCASTER DR
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34241-5722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-321-7171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST
-----------------------------------------------------
Name | DR. DIANA MAY HEBERT
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 941-321-7171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AP3697
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------