MEDICARE: DR. VIVIAN MONTOYA DACCHM, 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	20104	CA

General Provider Information

NPI Number	:	1255160768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIAN MONTOYA DACCHM, L.AC

Provider Business Mailing Address
First Line	:	4323 SEPULVEDA BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4715
Country	:	US
Telephone Number	:	213-858-1418
Fax Number	:	424-378-5120

Provider Business Practice Location Address
First Line	:	4323 SEPULVEDA BLVD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4715
Country	:	US
Telephone Number	:	213-858-1418
Fax Number	:	424-378-5120

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

Provider Enumeration Date	:	08/01/2024
Last Update Date	:	08/01/2024

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