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NPI Code Detail

MEDICARE: RADIANT SOURCE INC.

MEDICARE: RADIANT SOURCE 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
1171100000XAcupuncturistAP 3314FL

General Provider Information

NPI Number : 1821413790
Entity Type Code : Organization
Provider Name (Legal Business Name) : RADIANT SOURCE INC.
Provider Business Mailing Address
First Line : 120 BOABADILLA ST
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-1810
Country : US
Telephone Number : 786-344-5289
Fax Number :
Provider Business Practice Location Address
First Line : 7800 SW 57TH AVE
Second Line : SUITE 203
City : SOUTH MIAMI
State : FL
Zip : 33143-5537
Country : US
Telephone Number : 786-344-5289
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. CHRISTIAN TOROK
Credential : A.P.
Telephone Number : 786-344-5289
Provider Enumeration Date : 02/28/2014
Last Update Date : 09/17/2014

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Directions to “RADIANT SOURCE INC. ” Practice Location

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