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General NPI Number Information
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NPI Number | 1952440869
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Entity Type | Individual
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Provider Name | RANDEL B. WING DOM, LAC., NMD
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 822 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33990-2687
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Country | US
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Telephone | 239-989-9892
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Fax |
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Provider Business Mailing Address
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Address Line | 822 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33990-2687
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Country | US
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Telephone | 239-989-9892
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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 | AP3084
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License Number State | FL
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