MEDICARE: HOLISTIC APOTHECARY AND PREVENTIVE ACUPUNCTURE, INC.

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	AC4893	CA

General Provider Information

NPI Number	:	1023165370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC APOTHECARY AND PREVENTIVE ACUPUNCTURE, INC.

Provider Business Mailing Address
First Line	:	6753 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-1218
Country	:	US
Telephone Number	:	323-467-8637
Fax Number	:	323-957-3023

Provider Business Practice Location Address
First Line	:	6753 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-1218
Country	:	US
Telephone Number	:	323-467-8637
Fax Number	:	323-957-3023

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HERSCHEL MANALO
Credential	:	L.AC.
Telephone Number	:	323-467-8637

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	08/22/2011

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