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NPI Code Detail

MEDICARE: NEW RADIANCE ANTIAGING INSTITUTE, INC.

MEDICARE: NEW RADIANCE ANTIAGING INSTITUTE, INC.
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
1171100000XAcupuncturistAP3358FL

General Provider Information

NPI Number : 1770021529
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW RADIANCE ANTIAGING INSTITUTE, INC.
Provider Business Mailing Address
First Line : 3955 RIVERSIDE AVE
Second Line : SUITE 351
City : JACKSONVILLE
State : FL
Zip : 32205-3312
Country : US
Telephone Number : 904-483-3841
Fax Number :
Provider Business Practice Location Address
First Line : 3955 RIVERSIDE AVE
Second Line : SUITE 351
City : JACKSONVILLE
State : FL
Zip : 32205-3312
Country : US
Telephone Number : 904-483-3841
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. CHRISTINA MARIE GAROPPO
Credential : DAOM
Telephone Number : 904-483-3841
Provider Enumeration Date : 02/01/2017
Last Update Date : 02/01/2017

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