1063645869 NPI number — NATUROPATHIC WISDOM

Table of content: (NPI 1063645869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063645869 NPI number — NATUROPATHIC WISDOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATUROPATHIC WISDOM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063645869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 S WINCHESTER BLVD
Provider Second Line Business Mailing Address:
STE E157
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95128-3901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-297-6877
Provider Business Mailing Address Fax Number:
408-296-6894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 S WINCHESTER BLVD
Provider Second Line Business Practice Location Address:
STE E157
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95128-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-297-6877
Provider Business Practice Location Address Fax Number:
404-829-6689
Provider Enumeration Date:
08/26/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOGG
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
408-297-6877

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X , with the licence number:  ND-125 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)