Provider Demographics
NPI:1336592831
Name:PANDI ACUPUNCTURE AND MASSAGE
Entity Type:Organization
Organization Name:PANDI ACUPUNCTURE AND MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN MASSAGE THERA
Authorized Official - Prefix:
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMTAP
Authorized Official - Phone:407-733-1012
Mailing Address - Street 1:115 N STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5492
Mailing Address - Country:US
Mailing Address - Phone:407-733-1012
Mailing Address - Fax:
Practice Address - Street 1:115 N STEWART AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5492
Practice Address - Country:US
Practice Address - Phone:407-733-1012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2758171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty