MEDICARE: PATRICIA KEIKO CRONIN L.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	AC-5416	CA

General Provider Information

NPI Number	:	1871354993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA KEIKO CRONIN L.AC.

Provider Business Mailing Address
First Line	:	4612 GLENCOE AVE UNIT 1
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-6355
Country	:	US
Telephone Number	:	310-729-3528
Fax Number	:

Provider Business Practice Location Address
First Line	:	13323 W WASHINGTON BLVD STE 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5163
Country	:	US
Telephone Number	:	310-729-3528
Fax Number	:

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

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	01/16/2024

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