Provider Demographics
NPI:1689058364
Name:TUTTLE CALLIS, CHERI LYNN (LAC)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:LYNN
Last Name:TUTTLE CALLIS
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:PO BOX 1582
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95001-1582
Mailing Address - Country:US
Mailing Address - Phone:831-239-0916
Mailing Address - Fax:
Practice Address - Street 1:14665 KENWOOD PL
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95012-9728
Practice Address - Country:US
Practice Address - Phone:831-239-0916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16460171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist