MEDICARE: MISS JILLIAN REBECCA RIFKIND EAMP

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	60414217	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	XDP154A23407	OTHER	CA	ANTHEM BLUE CROSS

General Provider Information

NPI Number	:	1447496955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JILLIAN REBECCA RIFKIND EAMP

Provider Business Mailing Address
First Line	:	PO BOX 65004
Second Line	:
City	:	PORT LUDLOW
State	:	WA
Zip	:	98365-0004
Country	:	US
Telephone Number	:	661-478-8250
Fax Number	:

Provider Business Practice Location Address
First Line	:	9481 OAK BAY RD
Second Line	:
City	:	PORT LUDLOW
State	:	WA
Zip	:	98365-9801
Country	:	US
Telephone Number	:	661-478-8250
Fax Number	:	206-238-8145

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

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	01/21/2021

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