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General NPI Number Information
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NPI Number | 1831634740
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Entity Type | Organization
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Legal Business Name | CULTURED BC CORP
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Dates
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Enumeration Date | 12/31/2016
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Last Update Date | 12/31/2016
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Provider Practice Location Address
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Address Line | 1290 N RIDGE BLVD APT 922
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City | CLERMONT
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State | FL
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Zip | 34711-2896
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Country | US
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Telephone | 407-319-8597
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Fax |
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Provider Business Mailing Address
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Address Line | 1290 N RIDGE BLVD APT 922
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City | CLERMONT
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State | FL
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Zip | 34711-2896
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Country | US
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Telephone | 407-319-8597
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CAMILO PEREZ
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Credential |
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Telephone | 407-319-8597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA67733
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License Number State | FL
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