MEDICARE: REGINA ALEXANDRA TARARA L.AC.

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	1608	MN

General Provider Information

NPI Number	:	1467181271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA ALEXANDRA TARARA L.AC.

Provider Business Mailing Address
First Line	:	1835 ALTA VISTA DR
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-6559
Country	:	US
Telephone Number	:	651-210-9423
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 BROOKSIDE AVE
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-2809
Country	:	US
Telephone Number	:	651-210-9423
Fax Number	:

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

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	06/07/2022

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