Provider Demographics
NPI:1437534567
Name:CENTER FOR ADVANCED ACUPUNCTURE & INTEGRATIVE MEDICINE LLC
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED ACUPUNCTURE & INTEGRATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES, OWNER, MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:DEBONA
Authorized Official - Suffix:
Authorized Official - Credentials:AP, DOM, LAP
Authorized Official - Phone:813-588-2028
Mailing Address - Street 1:13920 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-4904
Mailing Address - Country:US
Mailing Address - Phone:813-588-2028
Mailing Address - Fax:813-434-2277
Practice Address - Street 1:13920 7TH ST
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4904
Practice Address - Country:US
Practice Address - Phone:813-588-2028
Practice Address - Fax:813-434-2277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR ADVANCED ACUPUNCTURE & INTEGRATIVE MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-30
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL13000035136171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1033255575OtherACUPUNCTURE