MEDICARE: DORAL ACUPUNCTURE 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

General Provider Information

NPI Number	:	1629679022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORAL ACUPUNCTURE LLC

Provider Business Mailing Address
First Line	:	3250 SW 20TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-2254
Country	:	US
Telephone Number	:	305-903-9364
Fax Number	:

Provider Business Practice Location Address
First Line	:	3399 NW 72ND AVE STE 224
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33122-1344
Country	:	US
Telephone Number	:	305-903-9364
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	VICTORIA CANDELA FERNANDEZ
Credential	:
Telephone Number	:	305-903-9364

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	11/03/2020

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