Provider Demographics
NPI:1134669674
Name:JESSICA ROSE SIANI, NATUROPATHIC DOCTOR, INC.
Entity Type:Organization
Organization Name:JESSICA ROSE SIANI, NATUROPATHIC DOCTOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:SIANI
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:949-743-5770
Mailing Address - Street 1:1831 ORANGE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1831 ORANGE AVE
Practice Address - Street 2:STE A
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2839
Practice Address - Country:US
Practice Address - Phone:949-743-5770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-447261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service