Healthcare Provider Details

I. General information

NPI: 1205080017
Provider Name (Legal Business Name): CHRISTINE RENEE VITIELLO L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 WEBSTER ST STE 206
SAN FRANCISCO CA
94115-3795
US

IV. Provider business mailing address

1489 WEBSTER ST STE 206
SAN FRANCISCO CA
94115-3795
US

V. Phone/Fax

Practice location:
  • Phone: 415-602-5002
  • Fax: 415-520-5387
Mailing address:
  • Phone: 415-602-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 12593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: