MEDICARE: INTEGRATED ACUPUNCTURE SERVICES, A PROFESSIONAL CORPORATION

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	261QH0100X	Health Service Clinic/Center	AC 8417	CA

General Provider Information

NPI Number	:	1336396712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED ACUPUNCTURE SERVICES, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 757
Second Line	:
City	:	AVILA BEACH
State	:	CA
Zip	:	93424-0757
Country	:	US
Telephone Number	:	805-705-1792
Fax Number	:	805-705-1792

Provider Business Practice Location Address
First Line	:	6639A BAY LAUREL PL
Second Line	:
City	:	AVILA BEACH
State	:	CA
Zip	:	93424-3504
Country	:	US
Telephone Number	:	805-705-1792
Fax Number	:	805-705-1792

Authorized Official
Title or Position	:	CEO
Name	:	DR. MARY JANE MEES
Credential	:	LAC DAOM
Telephone Number	:	805-705-1792

Provider Enumeration Date	:	08/27/2008
Last Update Date	:	11/13/2019

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