Provider Demographics
NPI:1932377017
Name:TINOCO, JAIME (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:
Last Name:TINOCO
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 YELLOWHEART WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-4859
Mailing Address - Country:US
Mailing Address - Phone:954-682-5814
Mailing Address - Fax:954-920-8013
Practice Address - Street 1:500 SE 17TH ST
Practice Address - Street 2:STE # 220
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2547
Practice Address - Country:US
Practice Address - Phone:954-682-5814
Practice Address - Fax:954-922-8050
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP00435171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist