Provider Demographics
NPI:1295276756
Name:ETERNAL ACUPUNCTURE LLC
Entity type:Organization
Organization Name:ETERNAL ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KORNELIA
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:VITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DIPLOM
Authorized Official - Phone:561-706-2642
Mailing Address - Street 1:2825 N CLEARBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4564
Mailing Address - Country:US
Mailing Address - Phone:561-452-6645
Mailing Address - Fax:
Practice Address - Street 1:2061 NW 2ND AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6776
Practice Address - Country:US
Practice Address - Phone:561-706-2642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3755171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty