Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1124771654 |
---|---|
Provider Name | Alexis White |
First Address | San Anselmo, CA 94960-2672 |
Second Address | San Anselmo, CA 94960-2672 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2022 |
Last Update Date | 03/02/2022 |