Healthcare Provider Details

I. General information

NPI: 1942020441
Provider Name (Legal Business Name): ANNE SHELTON CRUTE DAOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 WALNUT ST STE D
BERKELEY CA
94709-1564
US

IV. Provider business mailing address

1508 WALNUT ST STE D
BERKELEY CA
94709-1564
US

V. Phone/Fax

Practice location:
  • Phone: 415-527-7142
  • Fax: 415-527-7142
Mailing address:
  • Phone: 415-527-7142
  • Fax: 415-527-7142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: