Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 15-1515 | AZ |
Y | 175F00000X | Naturopath | 769 | CA |
NPI | 1023479110 |
---|---|
Provider Name | Stefan Kasian |
First Address | San Diego, CA 92121-1407 |
Second Address | San Diego, CA 92121-1429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2016 |
Last Update Date | 16/03/2016 |