Provider Demographics
NPI:1336554781
Name:LGACUPUNCTURE INC
Entity type:Organization
Organization Name:LGACUPUNCTURE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDERA
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:954-678-8457
Mailing Address - Street 1:1555 BONAVENTURE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-4041
Mailing Address - Country:US
Mailing Address - Phone:954-678-8457
Mailing Address - Fax:
Practice Address - Street 1:1555 BONAVENTURE BLVD
Practice Address - Street 2:SUITE 1004
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-4041
Practice Address - Country:US
Practice Address - Phone:954-678-8457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3771171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty