MEDICARE: MOONSHADOW ACUPUNCTURE A PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1770165011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOONSHADOW ACUPUNCTURE A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	3900 IRVING ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1217
Country	:	US
Telephone Number	:	415-429-1567
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 IRVING ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1217
Country	:	US
Telephone Number	:	415-429-1567
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RAYNA LEONORA SAVROSA
Credential	:	L.AC., DACM
Telephone Number	:	415-429-1567

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	11/26/2024

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