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General NPI Number Information
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NPI Number | 1629591607
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Entity Type | Organization
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Legal Business Name | BUDDHA'S DEN WELLNESS CENTER LLC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/20/2017
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Provider Practice Location Address
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Address Line | 2741 EXECUTIVE PARK DR STE 4
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City | WESTON
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State | FL
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Zip | 33331-3641
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Country | US
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Telephone | 954-900-9708
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Fax |
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Provider Business Mailing Address
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Address Line | 11051 NW 11TH CT
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City | PLANTATION
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State | FL
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Zip | 33322-7830
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Country | US
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Telephone | 516-304-8078
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MONICA A DE MASI
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Credential | AP, LAC, LMT
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Telephone | 516-304-8078
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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 | 2752
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License Number State | FL
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