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General NPI Number Information
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NPI Number | 1871207712
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Entity Type | Organization
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Legal Business Name | STIX R US, LLC
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 611 SPICE TRADER WAY APT G
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City | ORLANDO
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State | FL
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Zip | 32818-7441
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Country | US
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Telephone | 407-408-2580
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Fax |
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Provider Business Mailing Address
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Address Line | 611 SPICE TRADER WAY APT G
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City | ORLANDO
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State | FL
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Zip | 32818-7441
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Country | US
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Telephone | 407-408-2580
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LATISHA DAVIS
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Credential | CPT
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Telephone | 407-408-2580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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