MEDICARE: PAULI IIDA ACUPUNCTURE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1073443776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAULI IIDA ACUPUNCTURE LLC

Provider Business Mailing Address
First Line	:	5009 PADRE BLVD STE 12
Second Line	:
City	:	SOUTH PADRE ISLAND
State	:	TX
Zip	:	78597-7400
Country	:	US
Telephone Number	:	907-299-7005
Fax Number	:

Provider Business Practice Location Address
First Line	:	5009 PADRE BLVD STE 12
Second Line	:
City	:	SOUTH PADRE ISLAND
State	:	TX
Zip	:	78597-7400
Country	:	US
Telephone Number	:	907-299-7005
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	PAULI IIDA
Credential	:	LAC
Telephone Number	:	907-299-7005

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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