=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700598737
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NENINGER ORIENTAL MEDICINE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2022
-----------------------------------------------------
Last Update Date | 12/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10641 SW 108TH AVE APT 3D
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-516-5065
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8306 MILLS DR STE 688
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33183-4838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-516-5065
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACUPUNCTURIST PHYSICIAN
-----------------------------------------------------
Name | DR. LAZARO RODRIGUEZ-NENINGER
-----------------------------------------------------
Credential | AP
-----------------------------------------------------
Telephone | 786-516-5065
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------