MEDICARE: BOSA ACUPUNCTURE WELLNESS PLLC

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

General Provider Information

NPI Number	:	1518530518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSA ACUPUNCTURE WELLNESS PLLC

Provider Business Mailing Address
First Line	:	346 SENECA ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14204-2056
Country	:	US
Telephone Number	:	716-578-4734
Fax Number	:

Provider Business Practice Location Address
First Line	:	346 SENECA ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14204-2056
Country	:	US
Telephone Number	:	716-578-4734
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DANIEL DOMINGUEZ
Credential	:	LAC
Telephone Number	:	716-578-4734

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	07/19/2021

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