MEDICARE: SUZANNE K HARRIS 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 10232	CA

General Provider Information

NPI Number	:	1992922694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE K HARRIS L.AC.

Provider Business Mailing Address
First Line	:	26165 SANZ
Second Line	:	UNIT A
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6896
Country	:	US
Telephone Number	:	714-747-9596
Fax Number	:

Provider Business Practice Location Address
First Line	:	22992 EL TORO RD
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-4961
Country	:	US
Telephone Number	:	949-770-5356
Fax Number	:

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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