MEDICARE: MRS. MACPHERSON JAGERSON WOROBEC L.AC., CMT

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	004577-1	NY
2	225700000X	Massage Therapist	48836	CA
3	171100000X	Acupuncturist	16664	CA

General Provider Information

NPI Number	:	1174937478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MACPHERSON JAGERSON WOROBEC L.AC., CMT

Provider Business Mailing Address
First Line	:	PO BOX 26038
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92196-0038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4549 33RD ST
Second Line	:	UNIT 4
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-4493
Country	:	US
Telephone Number	:	646-421-5533
Fax Number	:

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

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	05/13/2015

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