Healthcare Provider Details

I. General information

NPI: 1003846775
Provider Name (Legal Business Name): RANDALL NEUSTAEDTER OMD, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1779 WOODSIDE RD 201C
REDWOOD CITY CA
94061-3498
US

IV. Provider business mailing address

1779 WOODSIDE RD 201C
REDWOOD CITY CA
94061-3498
US

V. Phone/Fax

Practice location:
  • Phone: 650-299-9170
  • Fax: 650-299-9173
Mailing address:
  • Phone: 650-299-9170
  • Fax: 650-299-9173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: