Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 64717 | MN |
N | 207Q00000X | Family Doctor | 64717 | MN |
NPI | 1841604451 |
---|---|
Provider Name | Sarah B. Astorga |
First Address | Fargo, ND 58103-4940 |
Second Address | Duluth, MN 55805-1951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2014 |
Last Update Date | 29/10/2018 |