MEDICARE: MR. MARK JEFFREY RUSKIN 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	AC5757	CA

General Provider Information

NPI Number	:	1619354917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK JEFFREY RUSKIN L.AC.

Provider Business Mailing Address
First Line	:	5121 EVALITA LN
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93111-2515
Country	:	US
Telephone Number	:	805-964-9987
Fax Number	:	805-964-9965

Provider Business Practice Location Address
First Line	:	5121 EVALITA LN
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93111-2515
Country	:	US
Telephone Number	:	805-964-9987
Fax Number	:	805-964-9965

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

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	05/06/2015

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