MEDICARE: SARAH HARDESTY 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	AC12870	CA

General Provider Information

NPI Number	:	1134453962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH HARDESTY L.AC.

Provider Business Mailing Address
First Line	:	9412 TWIN LAKES AVE
Second Line	:
City	:	ORANGEVALE
State	:	CA
Zip	:	95662-5423
Country	:	US
Telephone Number	:	916-990-3752
Fax Number	:

Provider Business Practice Location Address
First Line	:	8605 AUBURN FOLSOM RD
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-6202
Country	:	US
Telephone Number	:	916-791-7313
Fax Number	:

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

Provider Enumeration Date	:	09/26/2009
Last Update Date	:	09/26/2009

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