Provider Demographics
NPI:1588931307
Name:LOTUS BLOSSOM CLINIC
Entity type:Organization
Organization Name:LOTUS BLOSSOM CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:239-277-1399
Mailing Address - Street 1:6710 WINKLER RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-7274
Mailing Address - Country:US
Mailing Address - Phone:239-277-1399
Mailing Address - Fax:
Practice Address - Street 1:6710 WINKLER RD
Practice Address - Street 2:SUITE #2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7274
Practice Address - Country:US
Practice Address - Phone:239-277-1399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2473171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty