Provider Demographics
NPI:1073065108
Name:PAKULA, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PAKULA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 TAFT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4387
Mailing Address - Country:US
Mailing Address - Phone:954-880-0090
Mailing Address - Fax:305-421-0463
Practice Address - Street 1:12301 TAFT ST STE 200
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4387
Practice Address - Country:US
Practice Address - Phone:954-880-0090
Practice Address - Fax:305-421-0463
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3614171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist