Provider Demographics
NPI:1003846775
Name:NEUSTAEDTER, RANDALL (OMD, LAC)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:NEUSTAEDTER
Suffix:
Gender:M
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1779 WOODSIDE RD
Mailing Address - Street 2:201C
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3498
Mailing Address - Country:US
Mailing Address - Phone:650-299-9170
Mailing Address - Fax:650-299-9173
Practice Address - Street 1:1779 WOODSIDE RD
Practice Address - Street 2:201C
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3498
Practice Address - Country:US
Practice Address - Phone:650-299-9170
Practice Address - Fax:650-299-9173
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1541171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist