Provider Demographics
NPI:1063674687
Name:MIAMI ORIENTAL MEDICINE, LLC
Entity Type:Organization
Organization Name:MIAMI ORIENTAL MEDICINE, LLC
Other - Org Name:GABLES OPTIMAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISSA
Authorized Official - Middle Name:H
Authorized Official - Last Name:NIRENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:305-567-1973
Mailing Address - Street 1:195 GIRALDA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5208
Mailing Address - Country:US
Mailing Address - Phone:305-567-1973
Mailing Address - Fax:
Practice Address - Street 1:195 GIRALDA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5208
Practice Address - Country:US
Practice Address - Phone:305-567-1973
Practice Address - Fax:305-567-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1850171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty