MEDICARE: MRS. MARIA SAGRARIO CORDERO MS, 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	74809401201	UT

General Provider Information

NPI Number	:	1538412267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA SAGRARIO CORDERO MS, L.AC

Provider Business Mailing Address
First Line	:	PO BOX 520477
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84152-0477
Country	:	US
Telephone Number	:	801-673-6795
Fax Number	:	801-415-9525

Provider Business Practice Location Address
First Line	:	2290 E 4500 S
Second Line	:	SUITE 110
City	:	HOLLADAY
State	:	UT
Zip	:	84117-4492
Country	:	US
Telephone Number	:	801-673-6795
Fax Number	:

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

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	10/18/2012

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