MEDICARE: MR. JASON BEITO 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 9429	CA

General Provider Information

NPI Number	:	1881747996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON BEITO L.AC

Provider Business Mailing Address
First Line	:	PO BOX 1225
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-7722
Country	:	US
Telephone Number	:	510-206-6622
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 SHATTUCK AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-2724
Country	:	US
Telephone Number	:	510-666-8248
Fax Number	:

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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