MEDICARE: AMY CARSON 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
1	171100000X	Acupuncturist	AC18697	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	D1813540	OTHER	CA	DMV

General Provider Information

NPI Number	:	1093346918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY CARSON L.AC

Provider Business Mailing Address
First Line	:	1050 WILBUR AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2028
Country	:	US
Telephone Number	:	714-249-3713
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 WILBUR AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2028
Country	:	US
Telephone Number	:	714-249-3713
Fax Number	:

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

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	01/29/2020

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