MEDICARE: HEIDI MERCEDES MARTINE 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	6589	CA

General Provider Information

NPI Number	:	1609077825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI MERCEDES MARTINE L.AC

Provider Business Mailing Address
First Line	:	42445 FIJI WAY
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92592-7107
Country	:	US
Telephone Number	:	951-694-1485
Fax Number	:

Provider Business Practice Location Address
First Line	:	28900 OLD TOWN FRONT ST
Second Line	:	STE. 103
City	:	TEMECULA
State	:	CA
Zip	:	92590-2856
Country	:	US
Telephone Number	:	951-694-1485
Fax Number	:

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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