Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 151514 | AZ |
NPI | 1073985875 |
---|---|
Provider Name | Dr. Graciela Brige Rundle |
First Address | Phoenix, AZ 85041-4946 |
Second Address | Phoenix, AZ 85041-4946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2015 |
Last Update Date | 20/10/2015 |