MEDICARE: MS. MARIA RAVIS 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	AC7823	CA

General Provider Information

NPI Number	:	1144368762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA RAVIS L.AC.

Provider Business Mailing Address
First Line	:	PO BOX 822
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-0822
Country	:	US
Telephone Number	:	310-640-2129
Fax Number	:

Provider Business Practice Location Address
First Line	:	523 MAIN ST
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-3006
Country	:	US
Telephone Number	:	310-640-2129
Fax Number	:

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

Provider Enumeration Date	:	02/03/2007
Last Update Date	:	07/08/2007

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Directions to “ MS. MARIA RAVIS L.AC.” Practice Location

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