MEDICARE: CARA JOLLY ACUPUNCTURE

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	225100000X	Physical Therapist
2	225700000X	Massage Therapist
3	171100000X	Acupuncturist	15026	CA

General Provider Information

NPI Number	:	1508220674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARA JOLLY ACUPUNCTURE

Provider Business Mailing Address
First Line	:	5486 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4218
Country	:	US
Telephone Number	:	323-954-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5486 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4218
Country	:	US
Telephone Number	:	323-954-8800
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CARA JOLLY
Credential	:	L.AC.,DIPL.O.M.
Telephone Number	:	323-954-8800

Provider Enumeration Date	:	04/05/2016
Last Update Date	:	04/05/2016

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Directions to “CARA JOLLY ACUPUNCTURE ” Practice Location

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