Provider Demographics
NPI:1053059139
Name:GOFORTH ACUPUNCTURE INC
Entity Type:Organization
Organization Name:GOFORTH ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:MAYA
Authorized Official - Last Name:GOFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:760-815-6265
Mailing Address - Street 1:699 N VULCAN AVE SPC 71A
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2131
Mailing Address - Country:US
Mailing Address - Phone:760-815-6265
Mailing Address - Fax:
Practice Address - Street 1:187 CALLE MAGDALENA STE 214
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3712
Practice Address - Country:US
Practice Address - Phone:760-815-6265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty