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General NPI Number Information
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NPI Number | 1740728583
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Entity Type | Organization
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Legal Business Name | THE GOLGI CLINIC, LLC
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 113 W FRONT ST SUITE 201
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City | MISSOULA
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State | MT
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Zip | 59802-4332
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Country | US
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Telephone | 406-541-8886
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Fax |
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Provider Business Mailing Address
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Address Line | 113 W FRONT ST SUITE 201
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City | MISSOULA
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State | MT
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Zip | 59802-4332
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Country | US
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Telephone | 406-541-8886
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Fax |
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Authorized Official
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Title or Position | OWNER, MEMBER
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Name | DR. TERESITA MARTINEZ
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Credential | ND
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Telephone | 406-360-9123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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