Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 28875 | CA |
NPI | 1285991158 |
---|---|
Provider Name | Ms. Brook Ashley Heathcoate - Powers |
First Address | Stockton, CA 95209-4703 |
Second Address | Stockton, CA 95209-4703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2012 |
Last Update Date | 20/06/2018 |