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General NPI Number Information
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NPI Number | 1396210860
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Entity Type | Individual
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Provider Name | CHISIE GUMOBAO KLINGLESMITH AP, DOM
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Gender | Female
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 1575 INDIAN RIVER BLVD STE C130
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City | VERO BEACH
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State | FL
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Zip | 32960-7134
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Country | US
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Telephone | 772-770-6184
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Fax | 772-770-6310
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Provider Business Mailing Address
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Address Line | 404 RED SAIL WAY
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City | SATELLITE BEACH
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State | FL
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Zip | 32937-3720
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | AP3986
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License Number State | FL
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