Basic Information
| Provider Information | |||||||||
| NPI: | 1144707068 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALTERNATIVE MEDICINE ACUPUNCTURE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 152592 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336842592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134442020 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2605 W SWANN AVE STE 600 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134442020 | ||||||||
| FaxNumber: | 8138771277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2018 | ||||||||
| LastUpdateDate: | 09/12/2020 | ||||||||
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| AuthorizedOfficialLastName: | GUEORGUIEV | ||||||||
| AuthorizedOfficialFirstName: | IVAYLO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8134442020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ALTERNATIVE MEDICINE ACUPUNCTURE | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DOM, AP | ||||||||
| NPICertificationDate: | 09/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | AP3960 | FL | N | Ambulatory Health Care Facilities | Clinic/Center | Health Service | 171100000X | AP3960 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Acupuncturist |
No ID Information.