MEDICARE: MARY ELLEN BESTANI LIC.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	AC00615	TX

General Provider Information

NPI Number	:	1851694137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELLEN BESTANI LIC.AC

Provider Business Mailing Address
First Line	:	PO BOX 1438
Second Line	:
City	:	CRYSTAL BEACH
State	:	TX
Zip	:	77650-1438
Country	:	US
Telephone Number	:	409-225-2625
Fax Number	:	409-762-6464

Provider Business Practice Location Address
First Line	:	957 GULF RD
Second Line	:
City	:	CRYSTAL BEACH
State	:	TX
Zip	:	77650
Country	:	US
Telephone Number	:	409-225-2625
Fax Number	:	409-762-6464

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

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	12/08/2010

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