=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982381042
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON OCCHINO LAC, MACCHM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2023
-----------------------------------------------------
Last Update Date | 06/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5424 W US HWY 290 SERVICE RD STE #106
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-387-4002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9015 CATTLE BARON PATH #1302
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-904-1968
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC02101
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------