Provider Demographics
NPI:1801045596
Name:ORCUTT, JAN ELIZABETH (LAC)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:ELIZABETH
Last Name:ORCUTT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:712 D ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3709
Mailing Address - Country:US
Mailing Address - Phone:415-460-1250
Mailing Address - Fax:415-457-1222
Practice Address - Street 1:712 D ST
Practice Address - Street 2:SUITE J
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3709
Practice Address - Country:US
Practice Address - Phone:415-460-1250
Practice Address - Fax:415-457-1222
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2352171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist