=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629474622
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUND AND COLOR ACUPUNCTURE PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2014
-----------------------------------------------------
Last Update Date | 11/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9420 SW 77TH AVE SUITE 201
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-467-8024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11850 SW 102ND ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-2746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-467-8024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VANESSA A CISNEROS
-----------------------------------------------------
Credential | L.AC
-----------------------------------------------------
Telephone | 305-467-8024
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 3555
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------