MEDICARE: MR. NORBERT R DURFEE 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	AC 5792	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AC 5792	OTHER	CA	CA LICENSE ACUPUNCTURIST

General Provider Information

NPI Number	:	1760503411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NORBERT R DURFEE L.AC

Provider Business Mailing Address
First Line	:	905 S LAKE ST
Second Line	:	103
City	:	BURBANK
State	:	CA
Zip	:	91502-2436
Country	:	US
Telephone Number	:	818-842-4880
Fax Number	:	818-842-4816

Provider Business Practice Location Address
First Line	:	905 S LAKE ST
Second Line	:	103
City	:	BURBANK
State	:	CA
Zip	:	91502-2436
Country	:	US
Telephone Number	:	818-842-4880
Fax Number	:	818-842-4816

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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