Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1029 | CA |
N | 175F00000X | Naturopath | ND1029 | CA |
NPI | 1063983831 |
---|---|
Provider Name | Anna Feagan |
First Address | La Jolla, CA 92037-7665 |
Second Address | La Jolla, CA 92037-7665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2018 |
Last Update Date | 05/12/2018 |