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NPI Code Detail

MEDICARE: DR. CAMERON MUSTAIN DOM, LAC

MEDICARE: DR. CAMERON MUSTAIN DOM, 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
1171100000XAcupuncturist0951AZ
2171100000XAcupuncturist1168NM

General Provider Information

NPI Number : 1689100646
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAMERON MUSTAIN DOM, LAC
Provider Business Mailing Address
First Line : 6440 E BROADWAY BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85710-3504
Country : US
Telephone Number : 520-881-0827
Fax Number :
Provider Business Practice Location Address
First Line : 6440 E BROADWAY BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85710-3504
Country : US
Telephone Number : 520-881-0827
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2017
Last Update Date : 05/11/2017

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Directions to “ DR. CAMERON MUSTAIN DOM, LAC” Practice Location

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