Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ND1025 | CA |
NPI | 1043867005 |
---|---|
Provider Name | Lisa Fortes-Schramm |
First Address | Santa Cruz, CA 95062-2203 |
Second Address | Santa Cruz, CA 95062-2203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2019 |
Last Update Date | 23/08/2019 |