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NPI Code Detail

MEDICARE: THOMAS NOONAN L.AC.

MEDICARE:   THOMAS  NOONAN  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
1171100000XAcupuncturistAC17328CA

General Provider Information

NPI Number : 1023551421
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS NOONAN L.AC.
Provider Business Mailing Address
First Line : 3227 LINCOLN AVE APT 1
Second Line :
City : SAN DIEGO
State : CA
Zip : 92104-2059
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3227 LINCOLN AVE APT 1
Second Line :
City : SAN DIEGO
State : CA
Zip : 92104-2059
Country : US
Telephone Number : 201-463-2260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2016
Last Update Date : 09/26/2017

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Directions to “ THOMAS NOONAN L.AC.” Practice Location

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