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General NPI Number Information
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NPI Number | 1598166043
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Entity Type | Organization
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Legal Business Name | YOUTHFUL AGING HEALTH CENTER INC
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 5602 MARQUESAS CIR SUITE 105
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City | SARASOTA
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State | FL
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Zip | 34233-3310
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Country | US
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Telephone | 941-925-9532
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Fax | 941-925-9628
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Provider Business Mailing Address
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Address Line | 5602 MARQUESAS CIR SUITE 105
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City | SARASOTA
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State | FL
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Zip | 34233-3310
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Country | US
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Telephone | 941-925-9532
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Fax | 941-925-9628
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Authorized Official
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Title or Position | DIRECTOR/CEO
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Name | MS. NICCI KOBRITZ
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Credential |
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Telephone | 941-925-9532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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