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General NPI Number Information
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NPI Number | 1679785240
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Entity Type | Organization
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Legal Business Name | EAST WEST HOLISTIC MEDICINE CLINIC LLC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 506 SW FEDERAL HWY SUITE 101
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City | STUART
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State | FL
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Zip | 34994-2827
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Country | US
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Telephone | 772-600-7033
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Fax | 772-600-7083
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Provider Business Mailing Address
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Address Line | 506 SW FEDERAL HWY SUITE101
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City | STUART
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State | FL
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Zip | 34994-2827
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Country | US
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Telephone | 772-600-7033
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | MRS. NATALYA KLYUCHKO
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Credential | AP
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Telephone | 772-600-0073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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