Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 097 | MT |
NPI | 1003933565 |
---|---|
Provider Name | Dr. Paloma Regina Defuentes |
First Address | Bozeman, MT 59715-5819 |
Second Address | Bozeman, MT 59715-5819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 24/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
298728 | BLUE CROSS BLUE SHIELD (01) | MT |