MEDICARE: SARA GORMLEY KAUFMAN LAC

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	16386	CA

General Provider Information

NPI Number	:	1073295515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA GORMLEY KAUFMAN LAC

Provider Business Mailing Address
First Line	:	13460 S HIGHWAY 101
Second Line	:
City	:	HOPLAND
State	:	CA
Zip	:	95449-9609
Country	:	US
Telephone Number	:	707-894-5313
Fax Number	:

Provider Business Practice Location Address
First Line	:	13460 S HIGHWAY 101
Second Line	:
City	:	HOPLAND
State	:	CA
Zip	:	95449-9609
Country	:	US
Telephone Number	:	707-894-5313
Fax Number	:

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

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	08/03/2023

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