Healthcare Provider Details

I. General information

NPI: 1144707068
Provider Name (Legal Business Name): ALTERNATIVE MEDICINE ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 09/12/2020
Certification Date: 09/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 W SWANN AVE STE 600
TAMPA FL
33609
US

IV. Provider business mailing address

PO BOX 152592
TAMPA FL
33684-2592
US

V. Phone/Fax

Practice location:
  • Phone: 813-444-2020
  • Fax: 813-877-1277
Mailing address:
  • Phone: 813-444-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3960
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberAP3960
License Number StateFL

VIII. Authorized Official

Name: DR. IVAYLO GUEORGUIEV
Title or Position: OWNER
Credential: DOM, AP
Phone: 813-444-2020