Healthcare Provider Details

I. General information

NPI: 1720449754
Provider Name (Legal Business Name): CWBC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 GOODLETTE RD N
NAPLES FL
34102-5613
US

IV. Provider business mailing address

163 PLANTATION CIR
NAPLES FL
34104-6443
US

V. Phone/Fax

Practice location:
  • Phone: 239-404-0648
  • Fax:
Mailing address:
  • Phone: 305-409-5804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberAP322
License Number StateFL

VIII. Authorized Official

Name: DR. ROSEMARY LANG HARRIS
Title or Position: LICENSED ACUPUNCTURE PHYSICIAN
Credential: L. A. P.
Phone: 239-404-0648