MEDICARE: TERESA BECKWITH, 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	9410	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LAC 9410	OTHER	CA	ACUPUNCTURE BOARD, CALIFORNIA BOARD OF CONSUMER AFFAIRS

General Provider Information

NPI Number	:	1326426933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERESA BECKWITH, LAC

Provider Business Mailing Address
First Line	:	5514 CABALLOS PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-3725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5514 CABALLOS PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-3725
Country	:	US
Telephone Number	:	619-908-0228
Fax Number	:

Authorized Official
Title or Position	:	LICENSED ACUPUNCTURIST
Name	:	TERESA BECKWITH
Credential	:	MSTOM, LAC
Telephone Number	:	619-908-0228

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	05/14/2015

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