Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | #ND775 | CA |
NPI | 1053776229 |
---|---|
Provider Name | Cameron O'connell |
First Address | Santa Rosa, CA 95404-3058 |
Second Address | Santa Rosa, CA 95404-3568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2015 |
Last Update Date | 15/12/2015 |