Healthcare Provider Details

I. General information

NPI: 1568289981
Provider Name (Legal Business Name): NEIL GUMENICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 7TH ST STE 202
SANTA MONICA CA
90401-2631
US

IV. Provider business mailing address

8414 FARM RD # 180305
LAS VEGAS NV
89131-8170
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-2235
  • Fax:
Mailing address:
  • Phone: 702-878-2841
  • Fax: 702-878-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC1282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: