MEDICARE: MISS ALIA KRISTEN MACIAS LAC

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	12731	CA

General Provider Information

NPI Number	:	1174776512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ALIA KRISTEN MACIAS LAC

Provider Business Mailing Address
First Line	:	4586 LISANN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117
Country	:	US
Telephone Number	:	619-573-0912
Fax Number	:

Provider Business Practice Location Address
First Line	:	4586 LISANN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2439
Country	:	US
Telephone Number	:	619-573-0912
Fax Number	:

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

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	10/29/2008

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