MEDICARE: MRS. FARIVASH HAMRAIE L.AC (ACUPUNCTURIST)

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	AC00879	TX

General Provider Information

NPI Number	:	1356662092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FARIVASH HAMRAIE L.AC (ACUPUNCTURIST)

Provider Business Mailing Address
First Line	:	1550 W ROSEDALE ST STE 408
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7408
Country	:	US
Telephone Number	:	817-338-1919
Fax Number	:	817-338-1919

Provider Business Practice Location Address
First Line	:	1550 W ROSEDALE ST STE 408
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7408
Country	:	US
Telephone Number	:	817-338-1919
Fax Number	:	817-338-1919

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	06/17/2010

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