MEDICARE: FERTILIFE ACUPUNCTURE CLINIC

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	17049	CA

General Provider Information

NPI Number	:	1659812790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERTILIFE ACUPUNCTURE CLINIC

Provider Business Mailing Address
First Line	:	2525 E COLORADO BLVD STE 104
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3771
Country	:	US
Telephone Number	:	626-639-3538
Fax Number	:	626-639-3538

Provider Business Practice Location Address
First Line	:	2525 E COLORADO BLVD STE 104
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3771
Country	:	US
Telephone Number	:	626-639-3538
Fax Number	:	626-639-3538

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MISS YI TING LIAO
Credential	:
Telephone Number	:	626-639-3538

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	03/08/2017

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