MEDICARE: JESSICA DIANE BRETON 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	0779	AZ

General Provider Information

NPI Number	:	1295062743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DIANE BRETON L.AC

Provider Business Mailing Address
First Line	:	3210 E FORT LOWELL RD
Second Line	:	SUITE 103
City	:	TUCSON
State	:	AZ
Zip	:	85716-1682
Country	:	US
Telephone Number	:	520-539-7243
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 E FORT LOWELL RD
Second Line	:	SUITE 103
City	:	TUCSON
State	:	AZ
Zip	:	85716-1682
Country	:	US
Telephone Number	:	520-539-7243
Fax Number	:

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

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	08/26/2016

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