MEDICARE: MRS. JEAN REISS 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	AC9304	CA

General Provider Information

NPI Number	:	1811374952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN REISS AC

Provider Business Mailing Address
First Line	:	1527 21ST ST
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-4038
Country	:	US
Telephone Number	:	310-529-9040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1527 21ST ST
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-4038
Country	:	US
Telephone Number	:	310-529-9040
Fax Number	:

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

Provider Enumeration Date	:	04/28/2015
Last Update Date	:	04/28/2015

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