MEDICARE: STEPHANIE K MARTIN

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	16739	CA

General Provider Information

NPI Number	:	1568833275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE K MARTIN

Provider Business Mailing Address
First Line	:	1549 JOSEPHINE ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-1168
Country	:	US
Telephone Number	:	415-602-9444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1549 JOSEPHINE ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-1168
Country	:	US
Telephone Number	:	415-602-9444
Fax Number	:

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

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	10/08/2015

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