=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881041051
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST WEST ACUTHERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2016
-----------------------------------------------------
Last Update Date | 05/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5709 CAMELLIA DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32807-3212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-394-2966
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5709 CAMELLIA DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32807-3212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED ACUPUNCTURE PHYSICIAN
-----------------------------------------------------
Name | MS. JANELLE POCHINTESTA
-----------------------------------------------------
Credential | A.P.
-----------------------------------------------------
Telephone | 407-394-2966
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AP3308
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------