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NPI Code Detail

MEDICARE: MR. RANDY G SUTTLES

MEDICARE: MR. RANDY G SUTTLES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1750642195
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RANDY G SUTTLES
Provider Business Mailing Address
First Line : 1820 SCENIC AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94709-1395
Country : US
Telephone Number : 510-548-7270
Fax Number :
Provider Business Practice Location Address
First Line : 1820 SCENIC AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94709-1395
Country : US
Telephone Number : 510-548-7270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2012
Last Update Date : 02/03/2026

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