Provider Demographics
NPI:1235894304
Name:RIVERVIEW ACUPUNCTURE & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:RIVERVIEW ACUPUNCTURE & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:FERNANDA
Authorized Official - Last Name:CARVAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:813-399-6011
Mailing Address - Street 1:13712 MOONSTONE CANYON DR # A
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-3504
Mailing Address - Country:US
Mailing Address - Phone:813-399-6011
Mailing Address - Fax:267-502-1689
Practice Address - Street 1:10015 PARK PLACE AVE # A
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5303
Practice Address - Country:US
Practice Address - Phone:813-399-6011
Practice Address - Fax:267-502-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty