MEDICARE: MS. JANEL RICHARDSON LAC, MSTOM

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	18641	CA

General Provider Information

NPI Number	:	1235850785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANEL RICHARDSON LAC, MSTOM

Provider Business Mailing Address
First Line	:	5030 LAKIBA PALMER AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-3746
Country	:	US
Telephone Number	:	619-943-0162
Fax Number	:

Provider Business Practice Location Address
First Line	:	5030 LAKIBA PALMER AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-3746
Country	:	US
Telephone Number	:	619-943-0162
Fax Number	:

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

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	09/05/2022

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