Provider Demographics
NPI:1437513348
Name:SAINT LUCIE ACUPUNCTURE
Entity Type:Organization
Organization Name:SAINT LUCIE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA-MARCELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ-RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:772-444-7172
Mailing Address - Street 1:1775 SW GATLIN BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2794
Mailing Address - Country:US
Mailing Address - Phone:772-444-7172
Mailing Address - Fax:
Practice Address - Street 1:1775 SW GATLIN BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2794
Practice Address - Country:US
Practice Address - Phone:772-444-7172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3513171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty