Healthcare Provider Details

I. General information

NPI: 1881747996
Provider Name (Legal Business Name): JASON BEITO L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SHATTUCK AVE
BERKELEY CA
94704-2724
US

IV. Provider business mailing address

PO BOX 1225
SAN LEANDRO CA
94577-7722
US

V. Phone/Fax

Practice location:
  • Phone: 510-666-8248
  • Fax:
Mailing address:
  • Phone: 510-206-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 9429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: