MEDICARE: DR. SKYLAR STUMPF LAC, DTCM

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	19370	CA

General Provider Information

NPI Number	:	1154074425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SKYLAR STUMPF LAC, DTCM

Provider Business Mailing Address
First Line	:	550 WATER ST STE K2
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-4136
Country	:	US
Telephone Number	:	831-337-0699
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 WATER ST STE K2
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-4136
Country	:	US
Telephone Number	:	831-337-0699
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	02/26/2022

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