Healthcare Provider Details

I. General information

NPI: 1497892939
Provider Name (Legal Business Name): KAREN BETH CUTLER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 DWIGHT WAY SUITE 204 205
BERKELEY CA
94704
US

IV. Provider business mailing address

2006 DWIGHT WAY SUITE 204 205
BERKELEY CA
94704
US

V. Phone/Fax

Practice location:
  • Phone: 510-654-3873
  • Fax: 510-644-1294
Mailing address:
  • Phone: 510-654-3873
  • Fax: 510-644-1294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC4754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: