=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346314705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN HIATT CUTTER L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 10/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 E ST SUITE 100
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94901-2762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-847-9990
-----------------------------------------------------
Fax | 415-419-2120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 DURHAM RD
-----------------------------------------------------
City | SAN ANSELMO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94960-1605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-847-9990
-----------------------------------------------------
Fax | 415-459-2648
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 2799
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------