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General NPI Number Information
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NPI Number | 1790219905
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Entity Type | Organization
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Legal Business Name | FIFTH PIVOT ACUPUNCTURE CORP.
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 16650 N KENDALL DR STE 201
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City | MIAMI
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State | FL
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Zip | 33196-1280
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Country | US
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Telephone | 786-863-7088
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Fax |
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Provider Business Mailing Address
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Address Line | 16650 N KENDALL DR STE 201
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City | MIAMI
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State | FL
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Zip | 33196-1280
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Country | US
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Telephone | 786-863-7088
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JESSICA LYNN DEL VALLE
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Credential | L.AC.
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Telephone | 786-863-7088
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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 | AP3650
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License Number State | FL
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