Provider Demographics
NPI:1205080017
Name:VITIELLO, CHRISTINE RENEE (LAC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RENEE
Last Name:VITIELLO
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 1:1489 WEBSTER ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3795
Mailing Address - Country:US
Mailing Address - Phone:415-602-5002
Mailing Address - Fax:
Practice Address - Street 1:1489 WEBSTER ST STE 206
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3795
Practice Address - Country:US
Practice Address - Phone:415-602-5002
Practice Address - Fax:415-520-5387
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12593171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist