MEDICARE: MEDICA VITA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	3700	FL

General Provider Information

NPI Number	:	1538515242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICA VITA LLC

Provider Business Mailing Address
First Line	:	5357 BAMBOO CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-6723
Country	:	US
Telephone Number	:	407-936-4238
Fax Number	:

Provider Business Practice Location Address
First Line	:	5357 BAMBOO CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-6723
Country	:	US
Telephone Number	:	407-936-4238
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	ANDRIY CHETIN
Credential	:
Telephone Number	:	407-936-4238

Provider Enumeration Date	:	05/11/2016
Last Update Date	:	05/11/2016

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