Provider Demographics
NPI:1275909657
Name:MIAMI CENTER FOR ORIENTAL MEDICINE
Entity Type:Organization
Organization Name:MIAMI CENTER FOR ORIENTAL MEDICINE
Other - Org Name:NEEDLES AND MOXA WELLNESS CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGLIALONGA
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM, LAC
Authorized Official - Phone:305-265-5265
Mailing Address - Street 1:1317 OBISPO AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3511
Mailing Address - Country:US
Mailing Address - Phone:305-265-5265
Mailing Address - Fax:
Practice Address - Street 1:700 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-3922
Practice Address - Country:US
Practice Address - Phone:305-265-5265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2389261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service