MEDICARE: PURE INTENT ACUPUNCTURE, LLC

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	225700000X	Massage Therapist
2	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1710711593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE INTENT ACUPUNCTURE, LLC

Provider Business Mailing Address
First Line	:	107 W WASHINGTON ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85701-1011
Country	:	US
Telephone Number	:	602-615-1916
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 W WASHINGTON ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85701-1011
Country	:	US
Telephone Number	:	602-615-1916
Fax Number	:

Authorized Official
Title or Position	:	OWNER / PRACTITIONER
Name	:	MARY ALEJANDRA RODRIGUEZ
Credential	:	L.AC.
Telephone Number	:	602-615-1916

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	08/25/2025

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