Provider Demographics
NPI:1649663998
Name:HOMESTEAD ACUPUNCTURE
Entity type:Organization
Organization Name:HOMESTEAD ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAC,DOM
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:305-219-3264
Mailing Address - Street 1:229 S KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-7212
Mailing Address - Country:US
Mailing Address - Phone:305-219-3264
Mailing Address - Fax:
Practice Address - Street 1:229 S KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-7212
Practice Address - Country:US
Practice Address - Phone:305-219-3264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3471171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty