MEDICARE: BECKY D. HALY L.AC. M.S.

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	AC9611	CA

General Provider Information

NPI Number	:	1548473622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKY D. HALY L.AC. M.S.

Provider Business Mailing Address
First Line	:	5881 JACKSON DR
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-2619
Country	:	US
Telephone Number	:	619-303-7400
Fax Number	:	619-460-6316

Provider Business Practice Location Address
First Line	:	5677 OBERLIN DR STE 112
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1741
Country	:	US
Telephone Number	:	619-303-7400
Fax Number	:	619-460-6316

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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