MEDICARE: MS. VANESSA LEILANI TUCKER 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
1	171100000X	Acupuncturist	AC222827	OR

General Provider Information

NPI Number	:	1699590935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VANESSA LEILANI TUCKER LAC

Provider Business Mailing Address
First Line	:	1203B N SIGNAL ST
Second Line	:
City	:	OJAI
State	:	CA
Zip	:	93023-1831
Country	:	US
Telephone Number	:	805-826-8594
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 SE DOUGLAS ST # F-3
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-4499
Country	:	US
Telephone Number	:	805-826-8594
Fax Number	:

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

Provider Enumeration Date	:	11/21/2024
Last Update Date	:	05/22/2025

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