MEDICARE: GOLETA ACUPUNCTURE WELLNESS 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	AC12399	CA

General Provider Information

NPI Number	:	1649582396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLETA ACUPUNCTURE WELLNESS CLINIC

Provider Business Mailing Address
First Line	:	5266 HOLLISTER AVE
Second Line	:	SUITE 215
City	:	SANTA BARBARA
State	:	CA
Zip	:	93111
Country	:	US
Telephone Number	:	805-895-5507
Fax Number	:	895-967-7400

Provider Business Practice Location Address
First Line	:	5266 HOLLISTER AVE
Second Line	:	SUITE 215
City	:	SANTA BARBARA
State	:	CA
Zip	:	93111-2037
Country	:	US
Telephone Number	:	805-895-5507
Fax Number	:	895-967-7400

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DAIJING LIU WANG
Credential	:	L. AC.
Telephone Number	:	805-895-5507

Provider Enumeration Date	:	07/10/2010
Last Update Date	:	07/10/2010

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Directions to “GOLETA ACUPUNCTURE WELLNESS CLINIC ” Practice Location

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