Provider Demographics
NPI:1982168738
Name:RESTORATIVE ACUPUNCTURE & HERBS
Entity Type:Organization
Organization Name:RESTORATIVE ACUPUNCTURE & HERBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:NAOMI
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:954-304-4752
Mailing Address - Street 1:1130 NE 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2208
Mailing Address - Country:US
Mailing Address - Phone:954-304-4752
Mailing Address - Fax:
Practice Address - Street 1:2530 NE 15TH AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1310
Practice Address - Country:US
Practice Address - Phone:954-304-4752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty