MEDICARE: STAYSEA SUMNER L.AC. PHD

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	10658	CA

General Provider Information

NPI Number	:	1316162167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STAYSEA SUMNER L.AC. PHD

Provider Business Mailing Address
First Line	:	28633 S WESTERN AVE
Second Line	:	#202
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-0827
Country	:	US
Telephone Number	:	310-241-0947
Fax Number	:

Provider Business Practice Location Address
First Line	:	28633 S WESTERN AVE
Second Line	:	#202
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-0827
Country	:	US
Telephone Number	:	310-241-0947
Fax Number	:

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/17/2012

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