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General NPI Number Information
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NPI Number | 1023394095
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Entity Type | Organization
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Legal Business Name | G & C MEDICAL CENTER INC
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Dates
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Enumeration Date | 10/22/2011
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Last Update Date | 10/22/2011
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Provider Practice Location Address
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Address Line | 4048 EVANS AVE SUITE 208
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City | FORT MYERS
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State | FL
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Zip | 33901-9322
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Country | US
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Telephone | 786-991-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 4048 EVANS AVE SUITE 208
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City | FORT MYERS
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State | FL
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Zip | 33901-9322
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Country | US
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Telephone | 786-991-4400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. YENMA CONCEPCION
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Credential | MASSAGE THERAPIST
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Telephone | 239-244-4851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MA61848
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License Number State | FL
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