Organization
CRAFT BEHAVIORAL HEALTH CLINIC
Active
Other names
Craft Laser Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMED FAROOQUE MD, PHD (OWNER/DOCTOR)
(904) 379-5928
Entity
Organization
Contact information
Practice address
10175 FORTUNE PKWY UNIT 1106, JACKSONVILLE, FL 32256-6757
(904) 337-0768
(904) 379-5967
Mailing address
10175 FORTUNE PKWY UNIT 1106, JACKSONVILLE, FL 32256-6757
(904) 337-0768
(904) 379-5967
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EO2233
DEPARTMENT OF HEALTH ELECTROLOGIST LICENSE
FL
Enumeration date
06/12/2023
Last updated
06/12/2023
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