MEDICARE: MAUREENA BIVINS 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	8028	CA

General Provider Information

NPI Number	:	1609921634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREENA BIVINS L.AC.

Provider Business Mailing Address
First Line	:	31255 CEDAR VALLEY DR
Second Line	:	SUITE 307
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-4014
Country	:	US
Telephone Number	:	818-991-2600
Fax Number	:	805-529-7388

Provider Business Practice Location Address
First Line	:	31255 CEDAR VALLEY DR
Second Line	:	SUITE 307
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-4014
Country	:	US
Telephone Number	:	818-991-2600
Fax Number	:	805-529-7388

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/16/2013

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