Provider Demographics
NPI:1083985931
Name:BEZERRA DE MENEZES ACUPUNCTURE CLINIC, LLC
Entity Type:Organization
Organization Name:BEZERRA DE MENEZES ACUPUNCTURE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARILTON
Authorized Official - Middle Name:F
Authorized Official - Last Name:NUNES
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:305-206-4903
Mailing Address - Street 1:7441 WAYNE AVE
Mailing Address - Street 2:APT# 7-0
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-2534
Mailing Address - Country:US
Mailing Address - Phone:305-206-4903
Mailing Address - Fax:
Practice Address - Street 1:1380 NE MIAMI GARDENS DR
Practice Address - Street 2:SUITE 274
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-4707
Practice Address - Country:US
Practice Address - Phone:305-206-4903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3016171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty