Healthcare Provider Details

I. General information

NPI: 1871817056
Provider Name (Legal Business Name): GCN THERAPIES/GENYLIMA/SLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 S CONGRESS AVE STE 304
LAKE WORTH FL
33461-4722
US

IV. Provider business mailing address

5055 S CONGRESS AVE STE 304
LAKE WORTH FL
33461-4722
US

V. Phone/Fax

Practice location:
  • Phone: 561-966-3380
  • Fax: 561-966-7599
Mailing address:
  • Phone: 561-966-3380
  • Fax: 561-966-7599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. OCTAVIO LIMA
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 561-966-3380