Provider Demographics
NPI:1275936908
Name:SCIUTTO, CHARLIE (LAC)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:
Last Name:SCIUTTO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 GLEN ALBYN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-2219
Mailing Address - Country:US
Mailing Address - Phone:805-845-5021
Mailing Address - Fax:805-564-3251
Practice Address - Street 1:2915 GLEN ALBYN DR
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-2219
Practice Address - Country:US
Practice Address - Phone:805-845-5021
Practice Address - Fax:805-564-3251
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13635171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist