Provider Demographics
NPI:1194277608
Name:IM ACUPUNCTURE AND HERBAL MEDICINE, PLLC
Entity type:Organization
Organization Name:IM ACUPUNCTURE AND HERBAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:GUADAMUZ
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:512-621-2538
Mailing Address - Street 1:11500 SW 178TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4974
Mailing Address - Country:US
Mailing Address - Phone:512-621-2538
Mailing Address - Fax:
Practice Address - Street 1:11500 SW 178TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-4974
Practice Address - Country:US
Practice Address - Phone:512-621-2538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3673261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center