Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ND279 | CA |
NPI | 1053584680 |
---|---|
Provider Name | Dr. Todd A Maderis |
First Address | Larkspur, CA 94939 |
Second Address | Larkspur, CA 94939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2008 |
Last Update Date | 22/03/2021 |