MEDICARE: NOBUKO IDE LA.C

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	AC14934	CA

General Provider Information

NPI Number	:	1487908877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOBUKO IDE LA.C

Provider Business Mailing Address
First Line	:	3105 VETERAN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-3036
Country	:	US
Telephone Number	:	310-435-4478
Fax Number	:

Provider Business Practice Location Address
First Line	:	3105 VETERAN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-3036
Country	:	US
Telephone Number	:	310-435-4478
Fax Number	:

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

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	11/06/2012

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Directions to “ NOBUKO IDE LA.C” Practice Location

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