Provider Demographics
NPI:1467900449
Name:CACOLICI, CRYSTAL L (AP DIPL OM)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:CACOLICI
Suffix:
Gender:F
Credentials:AP DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 N ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-1420
Mailing Address - Country:US
Mailing Address - Phone:954-465-6531
Mailing Address - Fax:
Practice Address - Street 1:1732 NE 26TH ST STE 202
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305
Practice Address - Country:US
Practice Address - Phone:954-533-8044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3644171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist