Provider Demographics
NPI:1881127314
Name:JADE ACUPUNCTURE
Entity type:Organization
Organization Name:JADE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:561-789-5233
Mailing Address - Street 1:7815 NW BEACON SQUARE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1345
Mailing Address - Country:US
Mailing Address - Phone:561-789-5233
Mailing Address - Fax:
Practice Address - Street 1:7815 NW BEACON SQUARE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1345
Practice Address - Country:US
Practice Address - Phone:561-789-5233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3721171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty