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General NPI Number Information
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NPI Number | 1922472000
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Entity Type | Organization
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Legal Business Name | VIBRANCE WELLNESS LLC
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Dates
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Enumeration Date | 11/30/2015
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 460 W CENTRAL PKWY
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-2415
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Country | US
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Telephone | 407-682-7111
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Fax | 407-682-7180
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Provider Business Mailing Address
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Address Line | 460 W CENTRAL PKWY
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-2415
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Country | US
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Telephone | 407-682-7111
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Fax | 407-682-7180
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Authorized Official
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Title or Position | MNGR
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Name | MRS. LISA MENDOZA BEAURY
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Credential | D.O.M. / A.P.
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Telephone | 407-682-7111
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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 | AP3676
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License Number State | FL
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