MEDICARE: MRS. LUCY FRANCES JEANSONNE PAUSEBACK L.AC., C.M.T.

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	225700000X	Massage Therapist	31404	CA
2	171100000X	Acupuncturist	17251	CA

General Provider Information

NPI Number	:	1609001122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LUCY FRANCES JEANSONNE PAUSEBACK L.AC., C.M.T.

Provider Business Mailing Address
First Line	:	3236 32ND ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-4736
Country	:	US
Telephone Number	:	619-550-8511
Fax Number	:

Provider Business Practice Location Address
First Line	:	3236 32ND ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-4736
Country	:	US
Telephone Number	:	415-312-9348
Fax Number	:

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

Provider Enumeration Date	:	05/28/2009
Last Update Date	:	10/02/2016

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