Provider Demographics
NPI:1043654262
Name:FAMILY TREE ACUPUNCTURE PL
Entity Type:Organization
Organization Name:FAMILY TREE ACUPUNCTURE PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:AP, DOM
Authorized Official - Phone:386-944-5855
Mailing Address - Street 1:1334 FLORENCE CT
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-2310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 ORANGE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4338
Practice Address - Country:US
Practice Address - Phone:386-944-5855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3134171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty