Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 308 | CA |
NPI | 1063634822 |
---|---|
Provider Name | Dr. Jason A Servatius |
First Address | Berkeley, CA 94709 |
Second Address | Berkeley, CA 94704-2724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 21/08/2014 |