MEDICARE: MONICA KELLI RICHARDS 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	11974	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11974	OTHER	CA	ACUPUNCTURE LICENSE NUMBE

General Provider Information

NPI Number	:	1528247822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA KELLI RICHARDS L.AC

Provider Business Mailing Address
First Line	:	5618 PONCE AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4338
Country	:	US
Telephone Number	:	818-399-3731
Fax Number	:

Provider Business Practice Location Address
First Line	:	5618 PONCE AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4338
Country	:	US
Telephone Number	:	818-399-3731
Fax Number	:

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

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	11/02/2007

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