Provider Demographics
NPI:1417220385
Name:ORIENTAL MEDICINE HOLISTIC HEALTH CARE INC.
Entity type:Organization
Organization Name:ORIENTAL MEDICINE HOLISTIC HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:GOSSAGE
Authorized Official - Last Name:FAXAS
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:954-243-9093
Mailing Address - Street 1:3336 OLD OAK LN
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8438
Mailing Address - Country:US
Mailing Address - Phone:954-243-9093
Mailing Address - Fax:954-333-3556
Practice Address - Street 1:110 N FEDERAL HWY STE 204
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4300
Practice Address - Country:US
Practice Address - Phone:954-243-9093
Practice Address - Fax:954-333-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3023171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty