MEDICARE: MRS. KELLI MUIRAE ALEXANDER 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	AC11180	CA

General Provider Information

NPI Number	:	1154403046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLI MUIRAE ALEXANDER L.AC.

Provider Business Mailing Address
First Line	:	412 S POINSETTIA AVE
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-3345
Country	:	US
Telephone Number	:	310-714-5673
Fax Number	:

Provider Business Practice Location Address
First Line	:	4307 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4901
Country	:	US
Telephone Number	:	323-295-6887
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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