MEDICARE: MRS. JULIA ANN SUTTON 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	AC 14556	CA

General Provider Information

NPI Number	:	1699044867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIA ANN SUTTON L.AC.

Provider Business Mailing Address
First Line	:	132 LELAND ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4030
Country	:	US
Telephone Number	:	707-490-6654
Fax Number	:	707-595-4663

Provider Business Practice Location Address
First Line	:	132 LELAND ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4030
Country	:	US
Telephone Number	:	707-490-6654
Fax Number	:	707-595-4663

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

Provider Enumeration Date	:	12/17/2011
Last Update Date	:	11/20/2015

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