MEDICARE: CLARA LAURENCE 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	16702	CA

General Provider Information

NPI Number	:	1255705265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARA LAURENCE L.AC.

Provider Business Mailing Address
First Line	:	11021 GURLEY LN
Second Line	:
City	:	MENDOCINO
State	:	CA
Zip	:	95460-9584
Country	:	US
Telephone Number	:	707-813-0105
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E MANZANITA ST
Second Line	:	SUITE C
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-3054
Country	:	US
Telephone Number	:	707-813-0105
Fax Number	:

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

Provider Enumeration Date	:	11/15/2015
Last Update Date	:	11/15/2015

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Directions to “ CLARA LAURENCE L.AC.” Practice Location

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