# BODHI TRADITIONAL CHINESE MEDICINE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bodhi TCM
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871013649
- **Authorized official:** DR. ANDREA IZQUIERDO LAC, DOM (DR. OF CHINESE MEDICINE)
- **Authorized official phone:** (321) 312-0771

## Contact information

- **Practice address:** 304 S HARBOR CITY BLVD STE 101, MELBOURNE, FL 32901-1382
- **Practice address phone:** (321) 312-0771
- **Practice address fax:** (352) 204-8490
- **Mailing address:** 304 S HARBOR CITY BLVD STE 101, MELBOURNE, FL 32901-1382
- **Mailing address phone:** (321) 312-0771
- **Mailing address fax:** (352) 204-8490

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171100000X | Acupuncturist | AP3822 | FL | Yes |

## Other

- **Enumeration date:** 06/22/2017
- **Last updated:** 01/13/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1972031169 | PERSONAL NPI | — |