Provider Demographics
NPI:1215904784
Name:MCNUTT, MARINA I (RN LAC)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:I
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:RN LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33315 SANTIAGO RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510
Mailing Address - Country:US
Mailing Address - Phone:661-269-2020
Mailing Address - Fax:661-269-2120
Practice Address - Street 1:33315 SANTIAGO RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:CA
Practice Address - Zip Code:93510
Practice Address - Country:US
Practice Address - Phone:661-269-2020
Practice Address - Fax:661-269-2120
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8433171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist