MEDICARE: ROCHAN MARIE OLSON L. AC

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	14672	CA

General Provider Information

NPI Number	:	1225381502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROCHAN MARIE OLSON L. AC

Provider Business Mailing Address
First Line	:	1012 JUSTIN AVE
Second Line	:	APT C
City	:	GLENDALE
State	:	CA
Zip	:	91201-3681
Country	:	US
Telephone Number	:	818-268-4414
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 N LARCHMONT BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3014
Country	:	US
Telephone Number	:	323-461-7876
Fax Number	:

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

Provider Enumeration Date	:	10/23/2012
Last Update Date	:	10/23/2012

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