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General NPI Number Information
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NPI Number | 1801288907
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Entity Type | Organization
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Legal Business Name | THREE TREASURES ORIENTAL MEDICINE
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 02/26/2015
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Provider Practice Location Address
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Address Line | 3591 SW 146TH TER
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City | MIRAMAR
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State | FL
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Zip | 33027-3737
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Country | US
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Telephone | 305-790-2374
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Fax | 954-450-4004
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Provider Business Mailing Address
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Address Line | 3591 SW 146TH TER
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City | MIRAMAR
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State | FL
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Zip | 33027-3737
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Country | US
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Telephone | 305-790-2374
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Fax | 954-450-4004
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Authorized Official
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Title or Position | DOM
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Name | DR. SHONTIA JOHNSON
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Credential | L.AC
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Telephone | 305-790-2374
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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 | AP3296
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License Number State | FL
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