Provider Demographics
NPI:1275887804
Name:ACUFRESH INC
Entity Type:Organization
Organization Name:ACUFRESH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:561-703-8030
Mailing Address - Street 1:5055 DALEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1844
Mailing Address - Country:US
Mailing Address - Phone:561-703-8030
Mailing Address - Fax:
Practice Address - Street 1:5055 DALEWOOD LN
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-1844
Practice Address - Country:US
Practice Address - Phone:561-703-8030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3187171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty