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General NPI Number Information
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NPI Number | 1699070177
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Entity Type | Organization
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Legal Business Name | GLORAL BODY MIND LLC
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Dates
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Enumeration Date | 01/14/2011
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Last Update Date | 01/14/2011
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Provider Practice Location Address
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Address Line | 8290 NW 27TH ST STE 605
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City | DORAL
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State | FL
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Zip | 33122-1907
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Country | US
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Telephone | 305-463-0101
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Fax | 305-463-0066
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Provider Business Mailing Address
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Address Line | 8290 NW 27TH ST STE 605
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City | DORAL
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State | FL
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Zip | 33122-1907
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Country | US
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Telephone | 305-463-0101
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Fax | 305-463-0066
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Authorized Official
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Title or Position | ACCUPUNCTURIST
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Name | MRS. MARIA CLARA CABANAS
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Credential |
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Telephone | 305-463-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 2011007815
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License Number State | FL
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