Healthcare Provider Details

I. General information

NPI: 1306617618
Provider Name (Legal Business Name): FIDEL GOYTIA LAC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3207 OLD CHAPEL HILL RD
DURHAM NC
27707-3605
US

IV. Provider business mailing address

4 DUCK POND CT
DURHAM NC
27703-6096
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-9595
  • Fax:
Mailing address:
  • Phone: 915-443-4408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC-2209
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: