Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ND 573 | CA |
NPI | 1063750594 |
---|---|
Provider Name | Dr. Jacqueline Blakely |
First Address | San Francisco, CA 94107-2810 |
Second Address | San Francisco, CA 94107-2810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2013 |
Last Update Date | 17/01/2013 |