MEDICARE: BARONA ACUPUNCTURE & HERB CLINIC

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

General Provider Information

NPI Number	:	1619638251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARONA ACUPUNCTURE & HERB CLINIC

Provider Business Mailing Address
First Line	:	12131 BERTHA ST
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-7520
Country	:	US
Telephone Number	:	213-383-0007
Fax Number	:	866-621-2931

Provider Business Practice Location Address
First Line	:	3407 W 6TH ST STE 617
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-2553
Country	:	US
Telephone Number	:	213-383-0007
Fax Number	:	866-621-2931

Authorized Official
Title or Position	:	OWNER
Name	:	RICHARD PARK
Credential	:
Telephone Number	:	213-383-0007

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	12/04/2023

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