Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ND 110 | CA |
NPI | 1134169782 |
---|---|
Provider Name | Kristin Stiles Green |
First Address | Agoura Hills, CA 91301-2573 |
Second Address | Agoura Hills, CA 91301-2573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 23/07/2012 |