Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 04-799 | AZ |
NPI | 1104949510 |
---|---|
Provider Name | Yezid Alberto Callejas |
First Address | Mesa, AZ 85202-2606 |
Second Address | Mesa, AZ 85201-5359 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 08/07/2007 |