MEDICARE: AVA MARIE AMESCUA LMT, LAC.

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	ACU.0002044	CO
2	171100000X	Acupuncturist	MT.0013169	CO

General Provider Information

NPI Number	:	1740515550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVA MARIE AMESCUA LMT, LAC.

Provider Business Mailing Address
First Line	:	1859 S FLANDERS WAY
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80017-4631
Country	:	US
Telephone Number	:	720-291-3102
Fax Number	:

Provider Business Practice Location Address
First Line	:	1859 S FLANDERS WAY
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80017-4631
Country	:	US
Telephone Number	:	720-291-3102
Fax Number	:

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

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	10/24/2014

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