MEDICARE: TERESA L RISPOLI 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	AC5728	CA

General Provider Information

NPI Number	:	1497875918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA L RISPOLI L.AC.

Provider Business Mailing Address
First Line	:	28247 AGOURA RD
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2403
Country	:	US
Telephone Number	:	818-707-3126
Fax Number	:	818-707-2787

Provider Business Practice Location Address
First Line	:	28247 AGOURA RD
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-2403
Country	:	US
Telephone Number	:	818-707-3126
Fax Number	:	818-707-2787

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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