Provider Demographics
NPI:1467857169
Name:PINECREST ACUPUNCTURE INC
Entity Type:Organization
Organization Name:PINECREST ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:305-670-6696
Mailing Address - Street 1:9300 S DIXIE HWY
Mailing Address - Street 2:STE 106
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2935
Mailing Address - Country:US
Mailing Address - Phone:305-670-6696
Mailing Address - Fax:
Practice Address - Street 1:9300 S DIXIE HWY
Practice Address - Street 2:STE 106
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2935
Practice Address - Country:US
Practice Address - Phone:305-670-6696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3512171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty