MEDICARE: BETH-ELLEN FRIED 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	AC9356	CA

General Provider Information

NPI Number	:	1174682926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH-ELLEN FRIED L.AC.

Provider Business Mailing Address
First Line	:	2901 OCEAN PARK BLVD
Second Line	:	SUITE 207
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2919
Country	:	US
Telephone Number	:	310-863-1358
Fax Number	:	310-396-6763

Provider Business Practice Location Address
First Line	:	2901 OCEAN PARK BLVD
Second Line	:	SUITE 207
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2919
Country	:	US
Telephone Number	:	310-863-1358
Fax Number	:	310-396-6763

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

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	07/08/2007

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