Provider Demographics
NPI:1942415138
Name:RITTER, VADAN T (LAC)
Entity Type:Individual
Prefix:
First Name:VADAN
Middle Name:T
Last Name:RITTER
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 1:3056 HILLEGASS AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2514
Mailing Address - Country:US
Mailing Address - Phone:415-786-9693
Mailing Address - Fax:415-252-8710
Practice Address - Street 1:2120 MARKET ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1376
Practice Address - Country:US
Practice Address - Phone:415-786-9693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6989171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist