=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003343294
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLD POINT HEALING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4665 W ATLANTIC AVE STE C
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33445-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-303-7584
-----------------------------------------------------
Fax | 561-270-2871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4665 W ATLANTIC AVE STE C
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33445-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-303-7584
-----------------------------------------------------
Fax | 561-270-2871
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. OLIVIA JOSEPHINE GOLD
-----------------------------------------------------
Credential | AP
-----------------------------------------------------
Telephone | 954-303-7584
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AP3761
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------