MEDICARE: JENNIFER BISSET 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	15036	CA

General Provider Information

NPI Number	:	1205276987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BISSET L.AC.

Provider Business Mailing Address
First Line	:	1140 LAUREL ST
Second Line	:	SUITE C
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-5054
Country	:	US
Telephone Number	:	650-206-8116
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 LAUREL ST
Second Line	:	SUITE C
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-5054
Country	:	US
Telephone Number	:	650-206-8116
Fax Number	:

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	03/19/2014

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