Healthcare Provider Details

I. General information

NPI: 1114534021
Provider Name (Legal Business Name): GUY CIULLA L. AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W SPENCER AVE STE A
GUNNISON CO
81230-2546
US

IV. Provider business mailing address

PO BOX 2916
CRESTED BUTTE CO
81224-2916
US

V. Phone/Fax

Practice location:
  • Phone: 970-641-6788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU.0002382
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: