Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ND840 | CA |
NPI | 1003368838 |
---|---|
Provider Name | Sherry Su |
First Address | San Jose, CA 95125-5109 |
Second Address | San Jose, CA 95125-5109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2016 |
Last Update Date | 26/12/2016 |