Basic Information
| Provider Information | |||||||||
| NPI: | 1962678979 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHNEIDER | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | AC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2999 REGENT ST | ||||||||
| Address2: | STE 225 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947052146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107047760 | ||||||||
| FaxNumber: | 5107047765 | ||||||||
| Practice Location | |||||||||
| Address1: | 2999 REGENT ST | ||||||||
| Address2: | STE 225 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947052146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107047760 | ||||||||
| FaxNumber: | 5107047765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2008 | ||||||||
| LastUpdateDate: | 04/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | AC10647 | CA | Y | Other Service Providers | Acupuncturist |
ID Information
| ID | Type | State | Issuer | Description | AC10647 | 01 | CA | LICENCE NUMBER | OTHER |