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NPI Code Detail

MEDICARE: VANESSA L MOCK MAOM, L.AC.

MEDICARE: VANESSA L MOCK MAOM, 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
1171100000XAcupuncturist12165069-1201UT

General Provider Information

NPI Number : 1285216374
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA L MOCK MAOM, L.AC.
Provider Business Mailing Address
First Line : 3351 S EL SERRITO DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-4249
Country : US
Telephone Number : 267-255-2299
Fax Number :
Provider Business Practice Location Address
First Line : 34 S 500 E STE 202
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-1094
Country : US
Telephone Number : 801-582-2011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2021
Last Update Date : 04/27/2021

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Directions to “ VANESSA L MOCK MAOM, L.AC.” Practice Location

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