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General NPI Number Information
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NPI Number | 1881127314
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Entity Type | Organization
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Legal Business Name | JADE ACUPUNCTURE
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 7815 NW BEACON SQUARE BLVD STE 101
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City | BOCA RATON
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State | FL
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Zip | 33487-1345
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Country | US
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Telephone | 561-789-5233
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Fax |
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Provider Business Mailing Address
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Address Line | 7815 NW BEACON SQUARE BLVD STE 101
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City | BOCA RATON
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State | FL
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Zip | 33487-1345
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Country | US
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Telephone | 561-789-5233
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | AMY GONZALEZ
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Credential | LAC
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Telephone | 561-789-5233
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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 | AP3721
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License Number State | FL
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