MEDICARE: SANTA MONICA SUPERIOR ACUPUNCTURE CLINIC 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	225700000X	Massage Therapist
2	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1063973584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA MONICA SUPERIOR ACUPUNCTURE CLINIC INC.

Provider Business Mailing Address
First Line	:	1528 6TH ST STE 120
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-2564
Country	:	US
Telephone Number	:	310-592-8911
Fax Number	:

Provider Business Practice Location Address
First Line	:	1528 6TH ST STE 120
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-2564
Country	:	US
Telephone Number	:	310-592-8911
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANGER
Name	:	MR. MICHAEL PULFORD
Credential	:
Telephone Number	:	310-592-8911

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	03/27/2019

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