MEDICARE: NINA SARACENO MSTCM, 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	19259	CA

General Provider Information

NPI Number	:	1578271490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA SARACENO MSTCM, L.AC

Provider Business Mailing Address
First Line	:	838 4TH ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	838 4TH ST STE A
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4538
Country	:	US
Telephone Number	:	707-241-3126
Fax Number	:

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

Provider Enumeration Date	:	11/09/2022
Last Update Date	:	11/09/2022

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