MEDICARE: MR. MICHIEL COYOTE L.AC, C.M.T.

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 13658	CA

General Provider Information

NPI Number	:	1891066361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHIEL COYOTE L.AC, C.M.T.

Provider Business Mailing Address
First Line	:	7 BELMONT AVE
Second Line	:
City	:	FAIRFAX
State	:	CA
Zip	:	94930-1708
Country	:	US
Telephone Number	:	415-342-3533
Fax Number	:

Provider Business Practice Location Address
First Line	:	751 CENTER BLVD
Second Line	:
City	:	FAIRFAX
State	:	CA
Zip	:	94930-1764
Country	:	US
Telephone Number	:	415-419-5397
Fax Number	:

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

Provider Enumeration Date	:	01/15/2012
Last Update Date	:	01/15/2012

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