Provider Demographics
NPI:1083919492
Name:ANDERSON ACUPUNCTURE AND AESTHETICS CORP.
Entity Type:Organization
Organization Name:ANDERSON ACUPUNCTURE AND AESTHETICS CORP.
Other - Org Name:ANDERSON ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDERSON
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:GONCALVES
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:561-922-9391
Mailing Address - Street 1:23123 STATE ROAD 7 STE 236B
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-5489
Mailing Address - Country:US
Mailing Address - Phone:561-922-9391
Mailing Address - Fax:
Practice Address - Street 1:23123 STATE ROAD 7 STE 236B
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-5489
Practice Address - Country:US
Practice Address - Phone:561-922-9391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2745171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty