Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ND703 | CA |
NPI | 1144607482 |
---|---|
Provider Name | Dr. Jina M Ethelbah |
First Address | Scottsdale, AZ 85250-6027 |
Second Address | Oakland, AZ 94611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2015 |
Last Update Date | 06/05/2015 |