MEDICARE: DR. TARA MARIE SHAH DACM, LAC

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	AC19420	CA

General Provider Information

NPI Number	:	1578296455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARA MARIE SHAH DACM, LAC

Provider Business Mailing Address
First Line	:	16516 BERNARDO CENTER DR STE 320
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2552
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16516 BERNARDO CENTER DR STE 320
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2552
Country	:	US
Telephone Number	:	619-289-7757
Fax Number	:	619-353-0553

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

Provider Enumeration Date	:	07/07/2022
Last Update Date	:	05/31/2024

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