Provider Demographics
NPI:1972154896
Name:ACUNA MEDICAL LLC
Entity Type:Organization
Organization Name:ACUNA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-567-8212
Mailing Address - Street 1:4414 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6256
Mailing Address - Country:US
Mailing Address - Phone:561-686-3201
Mailing Address - Fax:
Practice Address - Street 1:1211 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-7315
Practice Address - Country:US
Practice Address - Phone:833-882-2862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty