Provider Demographics
NPI:1487149589
Name:GUEORGUIEV, IVAYLO (DOM, DACM, AP)
Entity type:Individual
Prefix:DR
First Name:IVAYLO
Middle Name:
Last Name:GUEORGUIEV
Suffix:
Gender:M
Credentials:DOM, DACM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 152592
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-2592
Mailing Address - Country:US
Mailing Address - Phone:813-444-2020
Mailing Address - Fax:813-877-1277
Practice Address - Street 1:2605 W SWANN AVE STE 600
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-444-2020
Practice Address - Fax:844-946-0885
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-30
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3960171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty