Provider Demographics
NPI:1699070177
Name:GLORAL BODY MIND LLC
Entity type:Organization
Organization Name:GLORAL BODY MIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CLARA
Authorized Official - Last Name:CABANAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-463-0101
Mailing Address - Street 1:8290 NW 27TH ST STE 605
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1907
Mailing Address - Country:US
Mailing Address - Phone:305-463-0101
Mailing Address - Fax:305-463-0066
Practice Address - Street 1:8290 NW 27TH ST STE 605
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1907
Practice Address - Country:US
Practice Address - Phone:305-463-0101
Practice Address - Fax:305-463-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2011007815302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization