Provider Demographics
NPI:1598067571
Name:TRADITIONAL ACUPUNCTURE SERVICES,LLC
Entity Type:Organization
Organization Name:TRADITIONAL ACUPUNCTURE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORA-VIERA
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, MD (COLOMBIA)
Authorized Official - Phone:954-200-4587
Mailing Address - Street 1:15800 PINES BLVD
Mailing Address - Street 2:SUITE 329
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1212
Mailing Address - Country:US
Mailing Address - Phone:954-200-4587
Mailing Address - Fax:
Practice Address - Street 1:15800 PINES BLVD
Practice Address - Street 2:SUITE 329
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1212
Practice Address - Country:US
Practice Address - Phone:954-200-4587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2891261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service