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General NPI Number Information
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NPI Number | 1821413790
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Entity Type | Organization
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Legal Business Name | RADIANT SOURCE INC.
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Dates
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Enumeration Date | 02/28/2014
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 7800 SW 57TH AVE SUITE 203
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5537
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Country | US
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Telephone | 786-344-5289
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Fax |
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Provider Business Mailing Address
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Address Line | 120 BOABADILLA ST
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City | CORAL GABLES
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State | FL
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Zip | 33134-1810
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Country | US
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Telephone | 786-344-5289
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHRISTIAN TOROK
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Credential | A.P.
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Telephone | 786-344-5289
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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 | AP 3314
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License Number State | FL
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