Provider Demographics
NPI:1316608714
Name:EASTERN ACUPUNCTURE WILTON MANORS
Entity type:Organization
Organization Name:EASTERN ACUPUNCTURE WILTON MANORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:APDAOM
Authorized Official - Phone:954-400-5044
Mailing Address - Street 1:13224 W BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33325-2228
Mailing Address - Country:US
Mailing Address - Phone:954-400-5504
Mailing Address - Fax:954-400-5503
Practice Address - Street 1:1201 NE 26TH ST STE 106
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1206
Practice Address - Country:US
Practice Address - Phone:954-400-5044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN ACUPUNCTURE AND WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1235397910OtherACUPUNCTURIST