Basic Information
| Provider Information | |||||||||
| NPI: | 1063740678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EGGLETON | ||||||||
| FirstName: | HADIJAH | ||||||||
| MiddleName: | VANADA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | L.AC. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | EGGLETON | ||||||||
| OtherFirstName: | HADIJAH | ||||||||
| OtherMiddleName: | SYLVIA VANADA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | ACUPUNCTURIST | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3939 HOLLYWOOD BLVD | ||||||||
| Address2: | MEDICAL RESEARCH CENTER: AL NISA CLINIC 3RD FLOOR | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330216749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542726011 | ||||||||
| FaxNumber: | 9542726012 | ||||||||
| Practice Location | |||||||||
| Address1: | 3939 HOLLYWOOD BLVD | ||||||||
| Address2: | MEDICAL RESEARCH CENTER: AL NISA CLINIC 3RD FLOOR | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330216749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542726011 | ||||||||
| FaxNumber: | 9542726012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2009 | ||||||||
| LastUpdateDate: | 11/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 2589 | FL | Y | Other Service Providers | Acupuncturist |
No ID Information.