Provider Demographics
NPI:1154665420
Name:CICUTO, DENISE (LAC)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:CICUTO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4407
Mailing Address - Country:US
Mailing Address - Phone:415-404-6109
Mailing Address - Fax:
Practice Address - Street 1:1801 BUSH ST STE 305
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5272
Practice Address - Country:US
Practice Address - Phone:415-404-6109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11729171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist