Provider Demographics
NPI:1053321612
Name:DUTARET, CLAUDINE GABRIELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDINE
Middle Name:GABRIELLA
Last Name:DUTARET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6925 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1829
Mailing Address - Country:US
Mailing Address - Phone:510-334-1482
Mailing Address - Fax:888-375-2135
Practice Address - Street 1:2070 CLINTON AVE DEPT
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4399
Practice Address - Country:US
Practice Address - Phone:510-522-3700
Practice Address - Fax:888-375-2135
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG803572084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G803570Medicaid
G49674Medicare UPIN