MEDICARE: EASTERN ACUPUNCTURE FORT LAUDERDALE

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	:	1740950195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN ACUPUNCTURE FORT LAUDERDALE

Provider Business Mailing Address
First Line	:	13224 W BROWARD BLVD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33325-2228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1244 S FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2074
Country	:	US
Telephone Number	:	954-400-5044
Fax Number	:	954-400-5043

Authorized Official
Title or Position	:	CO-OWNER
Name	:	JENNIFER CRUZ
Credential	:	DAOM. AP.
Telephone Number	:	786-236-6947

Provider Enumeration Date	:	09/16/2021
Last Update Date	:	09/21/2021

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Directions to “EASTERN ACUPUNCTURE FORT LAUDERDALE ” Practice Location

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