Provider Demographics
NPI:1427570068
Name:BOGUSLAW, KIRA RIO (LAC)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:RIO
Last Name:BOGUSLAW
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 FOXHILL CIR APT 108
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-8145
Mailing Address - Country:US
Mailing Address - Phone:407-803-1890
Mailing Address - Fax:
Practice Address - Street 1:500 SANFORD AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1973
Practice Address - Country:US
Practice Address - Phone:321-710-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3844171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist