Provider Demographics
NPI:1225455561
Name:NAMASTE HOLISTIC CENTER, CORP
Entity Type:Organization
Organization Name:NAMASTE HOLISTIC CENTER, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF ORIENTAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORA-VIERA
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, MD (COLOMBIA)
Authorized Official - Phone:954-200-4587
Mailing Address - Street 1:2103 RENAISSANCE BLVD
Mailing Address - Street 2:APT 201
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5691
Mailing Address - Country:US
Mailing Address - Phone:954-200-4587
Mailing Address - Fax:
Practice Address - Street 1:18503 PINES BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1404
Practice Address - Country:US
Practice Address - Phone:954-885-5279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2891261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service