MEDICARE: MS. BETHANNA MAIA MENELEY 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	A10820	CA

General Provider Information

NPI Number	:	1912030503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETHANNA MAIA MENELEY L.AC.

Provider Business Mailing Address
First Line	:	10642 SANTA MONICA BLVD STE 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4858
Country	:	US
Telephone Number	:	310-775-3388
Fax Number	:

Provider Business Practice Location Address
First Line	:	10642 SANTA MONICA BLVD STE 210
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4858
Country	:	US
Telephone Number	:	310-775-3388
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/09/2007

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