=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972571347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATURAL HEALTH ADVANTAGE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1321 N PALM AVE
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33026-3345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-392-7392
-----------------------------------------------------
Fax | 954-392-7886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1321 N PALM AVE
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33026-3345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-392-7392
-----------------------------------------------------
Fax | 954-392-7886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SIMONE SPEYER
-----------------------------------------------------
Credential | P.T,A.P,D.O.M,
-----------------------------------------------------
Telephone | 954-392-7392
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------