Provider Demographics
NPI:1073050183
Name:VITEZ, KORNELIA ANNA (AP, DIPLOM)
Entity Type:Individual
Prefix:MRS
First Name:KORNELIA
Middle Name:ANNA
Last Name:VITEZ
Suffix:
Gender:F
Credentials:AP, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 N CLEARBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4564
Mailing Address - Country:US
Mailing Address - Phone:561-452-6645
Mailing Address - Fax:
Practice Address - Street 1:2061 NW 2ND AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6776
Practice Address - Country:US
Practice Address - Phone:561-706-2642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3755171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist