Provider Demographics
NPI:1124389317
Name:HALLANDALE HEALTH SPA & CLINIC INC
Entity Type:Organization
Organization Name:HALLANDALE HEALTH SPA & CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALBA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:AP NC MA CT
Authorized Official - Phone:954-456-1440
Mailing Address - Street 1:213 EAST HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5524
Mailing Address - Country:US
Mailing Address - Phone:954-456-1440
Mailing Address - Fax:954-456-1165
Practice Address - Street 1:213 EAST HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009-5524
Practice Address - Country:US
Practice Address - Phone:954-456-1440
Practice Address - Fax:954-456-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty