MEDICARE: AMIR FARAMARZ ZAGROSS 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	AC4394	CA

General Provider Information

NPI Number	:	1780728295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIR FARAMARZ ZAGROSS L.AC.

Provider Business Mailing Address
First Line	:	1223 WILSHIRE BLVD
Second Line	:	SUITE 1605
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5400
Country	:	US
Telephone Number	:	310-826-2238
Fax Number	:	310-496-3047

Provider Business Practice Location Address
First Line	:	1223 WILSHIRE BLVD
Second Line	:	SUITE 1605
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5400
Country	:	US
Telephone Number	:	310-826-2238
Fax Number	:	310-496-3047

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	09/19/2012

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