MEDICARE: COVE ACUPUNCTURE & FUNCTIONAL MEDICINE INCORPORATED

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

General Provider Information

NPI Number	:	1811755762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVE ACUPUNCTURE & FUNCTIONAL MEDICINE INCORPORATED

Provider Business Mailing Address
First Line	:	1411 N AVENUE 50
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-1719
Country	:	US
Telephone Number	:	323-470-4143
Fax Number	:

Provider Business Practice Location Address
First Line	:	4306 MELROSE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-3511
Country	:	US
Telephone Number	:	323-484-4560
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALEXANDRA MARIA BRUEHL
Credential	:	L.AC.
Telephone Number	:	323-470-4143

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	03/06/2024

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