Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 16-1594 | AZ |
Y | 175F00000X | Naturopath | ND-911 | CA |
NPI | 1124579909 |
---|---|
Provider Name | Dr. Bianca Andrea Despotides |
First Address | San Jacinto, CA 92582-3763 |
Second Address | San Jacinto, CA 92583-5103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2016 |
Last Update Date | 11/05/2018 |