Provider Demographics
NPI:1831377415
Name:NG, RENE MICHAEL (DOM, LAC, AP)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:MICHAEL
Last Name:NG
Suffix:
Gender:M
Credentials:DOM, LAC, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 BURGOS DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-2713
Mailing Address - Country:US
Mailing Address - Phone:941-773-5156
Mailing Address - Fax:
Practice Address - Street 1:2650 BAHIA VISTA ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2635
Practice Address - Country:US
Practice Address - Phone:941-773-5156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2463171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12911OtherSTATE LICENSE
FLAP 2463OtherSTATE LICENSE