MEDICARE: OALISA GUO O.M.D.L.A.C

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	AC11957	CA

General Provider Information

NPI Number	:	1194161364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OALISA GUO O.M.D.L.A.C

Provider Business Mailing Address
First Line	:	9670 LAS TUNAS DR
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2139
Country	:	US
Telephone Number	:	626-286-1377
Fax Number	:	626-286-1377

Provider Business Practice Location Address
First Line	:	9670 LAS TUNAS DR
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2139
Country	:	US
Telephone Number	:	626-286-1377
Fax Number	:	626-286-1377

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

Provider Enumeration Date	:	05/15/2013
Last Update Date	:	12/15/2014

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