Provider Demographics
NPI:1770021529
Name:NEW RADIANCE ANTIAGING INSTITUTE, INC.
Entity Type:Organization
Organization Name:NEW RADIANCE ANTIAGING INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GAROPPO
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:904-483-3841
Mailing Address - Street 1:3955 RIVERSIDE AVE
Mailing Address - Street 2:SUITE 351
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-3312
Mailing Address - Country:US
Mailing Address - Phone:904-483-3841
Mailing Address - Fax:
Practice Address - Street 1:3955 RIVERSIDE AVE
Practice Address - Street 2:SUITE 351
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-3312
Practice Address - Country:US
Practice Address - Phone:904-483-3841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3358171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty