MEDICARE: MARK FREDERICK HERRO 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	AC10890	CA

General Provider Information

NPI Number	:	1386722502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK FREDERICK HERRO LAC

Provider Business Mailing Address
First Line	:	26 PACO MEDIANO
Second Line	:
City	:	CARMEL VALLEY
State	:	CA
Zip	:	93924
Country	:	US
Telephone Number	:	831-331-6110
Fax Number	:	831-659-7569

Provider Business Practice Location Address
First Line	:	6 DEL FINO PLACE
Second Line	:
City	:	CARMEL VALLEY
State	:	CA
Zip	:	93924
Country	:	US
Telephone Number	:	831-659-5180
Fax Number	:	831-659-7569

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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