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General NPI Number Information
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NPI Number | 1972887164
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Entity Type | Individual
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Provider Name | CAROLINE GOSSAGE FAXAS A.P.
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Gender | Female
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 103 NE 2ND AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33444-3703
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Country | US
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Telephone | 561-455-2147
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Fax | 561-455-2762
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Provider Business Mailing Address
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Address Line | 3336 OLD OAK LN
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City | HOLLYWOOD
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State | FL
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Zip | 33021-8438
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Country | US
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Telephone | 954-243-9093
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Fax | 954-333-3556
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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 | AP 3023
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License Number State | FL
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