MEDICARE: MR. SCOTT ROBERT WHITE 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	13156	CA

General Provider Information

NPI Number	:	1710211263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT ROBERT WHITE L.AC.

Provider Business Mailing Address
First Line	:	454 MISSION ST
Second Line	:	1
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-3043
Country	:	US
Telephone Number	:	626-372-3505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 FREMONT AVE
Second Line	:	G
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-3225
Country	:	US
Telephone Number	:	626-372-3505
Fax Number	:

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

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	09/30/2009

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