Provider Demographics
NPI:1013067024
Name:GOLDSTEIN, ALMA VANESSA (LAC, AP)
Entity Type:Individual
Prefix:MS
First Name:ALMA
Middle Name:VANESSA
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LAC, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 SW SAINT LUCIE WEST BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2134
Mailing Address - Country:US
Mailing Address - Phone:772-398-5400
Mailing Address - Fax:772-446-4651
Practice Address - Street 1:1430 SW SAINT LUCIE WEST BLVD STE 103
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2134
Practice Address - Country:US
Practice Address - Phone:772-398-5400
Practice Address - Fax:772-446-4651
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2064171100000X
NY00787171100000X
FLAP2064171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00787OtherACUPUNCTURE LICENSE
FLAP2064OtherACUPUNCTURE LICENSE