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General NPI Number Information
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NPI Number | 1477500981
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Entity Type | Individual
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Provider Name | GERALDINE MARY SHUTE L.AC
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Gender | Female
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1240 POWELL ST SUITE 2A
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City | EMERYVILLE
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State | CA
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Zip | 94608-2600
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Country | US
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Telephone | 510-672-2210
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Fax |
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Provider Business Mailing Address
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Address Line | 3518 NEVIN AVE
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City | RICHMOND
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State | CA
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Zip | 94805-2150
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Country | US
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Telephone | 510-215-7957
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 10541
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License Number State | CA
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