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General NPI Number Information
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NPI Number | 1023494762
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Entity Type | Organization
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Legal Business Name | GULF COAST ACUPUNCTURE PHYSICIANS
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Dates
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Enumeration Date | 08/05/2015
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 3850 S OSPREY AVE SUITE 204
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City | SARASOTA
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State | FL
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Zip | 34239-6829
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Country | US
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Telephone | 941-320-1719
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Fax |
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Provider Business Mailing Address
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Address Line | 3850 S OSPREY AVE SUITE 204
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City | SARASOTA
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State | FL
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Zip | 34239-6829
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Country | US
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Telephone | 941-320-1719
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JONATHAN WALD
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Credential | AP
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Telephone | 941-320-1719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP2534
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License Number State | FL
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