MEDICARE: MS. HOLLY BETH GOGUEN 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	AC 11826	CA

General Provider Information

NPI Number	:	1326218116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY BETH GOGUEN L.AC.

Provider Business Mailing Address
First Line	:	439 1/2 N OGDEN DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-1748
Country	:	US
Telephone Number	:	415-533-7023
Fax Number	:	323-857-1220

Provider Business Practice Location Address
First Line	:	915 S CATALINA AVE STE B
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-4795
Country	:	US
Telephone Number	:	310-543-2323
Fax Number	:	323-857-1220

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

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	07/21/2009

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