MEDICARE: JOSH TAVES LAC

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	16474	CA

General Provider Information

NPI Number	:	1326426743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSH TAVES LAC

Provider Business Mailing Address
First Line	:	1269 LINDELL DR
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94596-6040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 OAK RD STE 120
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-2039
Country	:	US
Telephone Number	:	925-785-7364
Fax Number	:

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

Provider Enumeration Date	:	05/18/2015
Last Update Date	:	09/23/2016

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