Healthcare Provider Details

I. General information

NPI: 1346300662
Provider Name (Legal Business Name): GERALD JOSEPH DJUTH L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 I ST
SACRAMENTO CA
95816-4309
US

IV. Provider business mailing address

9679 ELMIRA CIR
SACRAMENTO CA
95827-1117
US

V. Phone/Fax

Practice location:
  • Phone: 916-600-5853
  • Fax: 916-442-2008
Mailing address:
  • Phone: 916-600-5853
  • Fax: 916-442-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: