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General NPI Number Information
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NPI Number | 1801110622
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Entity Type | Organization
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Legal Business Name | EAST WEST HEALTH CENTER
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 04/29/2015
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Provider Practice Location Address
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Address Line | 1216 13TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-7345
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Country | US
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Telephone | 941-744-9770
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Fax | 941-527-0223
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Provider Business Mailing Address
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Address Line | 1216 13TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-7345
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Country | US
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Telephone | 941-744-9770
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Fax | 941-527-0223
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Authorized Official
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Title or Position | OWNER
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Name | MARTHA PELLETIER
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Credential | AP
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Telephone | 941-744-9770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | AP1663
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License Number State | FL
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