MEDICARE: SANDRA LEE WOCICKI 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	15792	CA

General Provider Information

NPI Number	:	1306268578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA LEE WOCICKI L.AC.

Provider Business Mailing Address
First Line	:	3342 CALIFORNIA ST
Second Line	:	UNIT A
City	:	BERKELEY
State	:	CA
Zip	:	94703-2631
Country	:	US
Telephone Number	:	510-919-5689
Fax Number	:

Provider Business Practice Location Address
First Line	:	6536 TELEGRAPH AVE
Second Line	:	A 201
City	:	OAKLAND
State	:	CA
Zip	:	94609-1192
Country	:	US
Telephone Number	:	510-919-5689
Fax Number	:

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

Provider Enumeration Date	:	01/07/2014
Last Update Date	:	09/13/2015

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