MEDICARE: MS. JODI WEITZ 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	CA7126	CA

General Provider Information

NPI Number	:	1912338823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JODI WEITZ L.AC

Provider Business Mailing Address
First Line	:	700 E ST STE 100
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-2763
Country	:	US
Telephone Number	:	415-457-7762
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 E ST STE 100
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-2763
Country	:	US
Telephone Number	:	415-457-7762
Fax Number	:

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

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	12/02/2013

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