MEDICARE: AVA J ZACK 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	847406
2	171100000X	Acupuncturist	16645	CA

General Provider Information

NPI Number	:	1770226912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVA J ZACK LAC

Provider Business Mailing Address
First Line	:	PO BOX 5671
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95063-5671
Country	:	US
Telephone Number	:	831-345-1244
Fax Number	:

Provider Business Practice Location Address
First Line	:	1537 PACIFIC AVE STE 300H
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-3982
Country	:	US
Telephone Number	:	831-401-5141
Fax Number	:	831-401-5143

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

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	07/15/2025

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