Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 2010021440 | CA |
NPI | 1780998427 |
---|---|
Provider Name | Andrea Humphries |
First Address | San Diego, CA 92110-4525 |
Second Address | San Diego, CA 92110-4525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2010 |
Last Update Date | 05/08/2010 |