MEDICARE: CARROL D MAURO 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	11546	CA

General Provider Information

NPI Number	:	1164087623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARROL D MAURO L.AC.

Provider Business Mailing Address
First Line	:	7644 SURREY LN
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-3815
Country	:	US
Telephone Number	:	510-710-0384
Fax Number	:

Provider Business Practice Location Address
First Line	:	5737 THORNHILL DR
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-2144
Country	:	US
Telephone Number	:	510-339-0767
Fax Number	:

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

Provider Enumeration Date	:	05/09/2019
Last Update Date	:	05/09/2019

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Directions to “ CARROL D MAURO L.AC.” Practice Location

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