MEDICARE: SACRED FORTUNE

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	:	1821726563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED FORTUNE

Provider Business Mailing Address
First Line	:	2362 SCOTT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2458
Country	:	US
Telephone Number	:	310-880-2216
Fax Number	:

Provider Business Practice Location Address
First Line	:	1159 LOGAN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3210
Country	:	US
Telephone Number	:	310-880-2216
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	TERESA THOMAS
Credential	:
Telephone Number	:	424-247-6468

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	08/10/2022

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Directions to “SACRED FORTUNE ” Practice Location

Language	Start Address	Practice Location

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