Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ND656 | CA |
NPI | 1023429859 |
---|---|
Provider Name | Diane Angela Fong |
First Address | Redwood City, CA 94065-1341 |
Second Address | Los Altos, CA 94065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2014 |
Last Update Date | 14/05/2014 |