Provider Demographics
NPI:1780176172
Name:RP ACUPUNCTURE, INC
Entity type:Organization
Organization Name:RP ACUPUNCTURE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, AP, DIPL OM
Authorized Official - Phone:386-447-0610
Mailing Address - Street 1:397 PALM COAST PKWY SW UNIT 5
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4777
Mailing Address - Country:US
Mailing Address - Phone:386-447-0610
Mailing Address - Fax:386-447-0670
Practice Address - Street 1:397 PALM COAST PKWY SW UNIT 4
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4777
Practice Address - Country:US
Practice Address - Phone:386-447-0610
Practice Address - Fax:386-447-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3945261Q00000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty