Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 0982 | OR |
N | 175F00000X | Naturopath | NT00001638 | WA |
NPI | 1083949531 |
---|---|
Provider Name | Dr. Mario E Roxas |
First Address | Sandpoint, ID 83864-8280 |
Second Address | Ponderay, ID 83852-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2009 |
Last Update Date | 15/10/2009 |