MEDICARE: MR. DYLAN QUINN JAWAHIR L.AC., L.M.T.

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	13828	CA
2	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1750691721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DYLAN QUINN JAWAHIR L.AC., L.M.T.

Provider Business Mailing Address
First Line	:	10910 POLARIS DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-2446
Country	:	US
Telephone Number	:	858-349-5057
Fax Number	:

Provider Business Practice Location Address
First Line	:	11848 BERNARDO PLAZA CT
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2416
Country	:	US
Telephone Number	:	858-349-5057
Fax Number	:

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

Provider Enumeration Date	:	10/08/2010
Last Update Date	:	10/08/2010

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