Provider Demographics
NPI:1811527542
Name:THOMINET, THI MINH LOAN
Entity type:Individual
Prefix:
First Name:THI MINH LOAN
Middle Name:
Last Name:THOMINET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9470 CORKSCREW PALMS CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3305
Mailing Address - Country:US
Mailing Address - Phone:239-849-2667
Mailing Address - Fax:
Practice Address - Street 1:9470 CORKSCREW PALMS CIR STE 102
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3305
Practice Address - Country:US
Practice Address - Phone:239-849-2667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4041171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty