MEDICARE: HOLLY BETH GOGUEN

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	AC11826	CA

General Provider Information

NPI Number	:	1114225760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLY BETH GOGUEN

Provider Business Mailing Address
First Line	:	439 1/2 N OGDEN DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-1748
Country	:	US
Telephone Number	:	323-937-4099
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 S CATALINA AVE
Second Line	:	SUITE B
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-4795
Country	:	US
Telephone Number	:	310-543-2323
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. HOLLY BETH GOGUEN
Credential	:	L.AC.
Telephone Number	:	415-533-7023

Provider Enumeration Date	:	03/07/2011
Last Update Date	:	03/07/2011

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