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General NPI Number Information
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NPI Number | 1689082869
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Entity Type | Organization
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Legal Business Name | REN 17 ACUPUNCTURE, CORP
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 747 PONCE DE LEON BLVD SUITE 600
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City | CORAL GABLES
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State | FL
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Zip | 33134-2049
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Country | US
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Telephone | 305-439-2413
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Fax | 305-447-6336
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Provider Business Mailing Address
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Address Line | 747 PONCE DE LEON BLVD SUITE 600
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City | CORAL GABLES
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State | FL
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Zip | 33134-2049
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Country | US
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Telephone | 305-439-2413
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Fax | 305-447-6336
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Authorized Official
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Title or Position | PRESIDENT
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Name | ADRIANA PATINO
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Credential | L. AC
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Telephone | 305-439-2413
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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 | AP3427
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License Number State | FL
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