MEDICARE: DIANA MARISCAL

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	AP2676	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP2676	OTHER	FL	ACUPUNCTURE
2	MA44739	OTHER	FL	MASSAGE THERAPY

General Provider Information

NPI Number	:	1396988606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA MARISCAL

Provider Business Mailing Address
First Line	:	5836 PETUNIA LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-5511
Country	:	US
Telephone Number	:	407-731-4511
Fax Number	:

Provider Business Practice Location Address
First Line	:	5836 PETUNIA LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-5511
Country	:	US
Telephone Number	:	407-731-4511
Fax Number	:

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

Provider Enumeration Date	:	04/16/2009
Last Update Date	:	04/16/2009

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Directions to “ DIANA MARISCAL ” Practice Location

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