MEDICARE: MARIA CAROLINA MONTUFAR 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	AC17669	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AC17669	OTHER	CA	STATE OF CALIFORNIA ACUPUNCTURE BOARD

General Provider Information

NPI Number	:	1275053126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA CAROLINA MONTUFAR L.AC.

Provider Business Mailing Address
First Line	:	3425 GREGORY DR
Second Line	:
City	:	BAY POINT
State	:	CA
Zip	:	94565-1512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 GREGORY DR
Second Line	:
City	:	BAY POINT
State	:	CA
Zip	:	94565-1512
Country	:	US
Telephone Number	:	925-421-4896
Fax Number	:

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

Provider Enumeration Date	:	06/22/2017
Last Update Date	:	06/22/2017

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