MEDICARE: MS. BLANCA M IVORY ACUPUNTURE PHYSICIAN

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	AP 1024	FL

General Provider Information

NPI Number	:	1629128376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BLANCA M IVORY ACUPUNTURE PHYSICIAN

Provider Business Mailing Address
First Line	:	3109 GRAND AVE
Second Line	:	#293
City	:	MIAMI
State	:	FL
Zip	:	33133-5103
Country	:	US
Telephone Number	:	305-610-4989
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 GRAND AVE
Second Line	:	#293
City	:	MIAMI
State	:	FL
Zip	:	33133-5103
Country	:	US
Telephone Number	:	305-610-4989
Fax Number	:

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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