Provider Demographics
NPI:1164611273
Name:JACQUES, BRETT (ND)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:JACQUES
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N RODEO DR
Mailing Address - Street 2:P5
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4500
Mailing Address - Country:US
Mailing Address - Phone:855-737-7704
Mailing Address - Fax:
Practice Address - Street 1:421 N RODEO DR.
Practice Address - Street 2:P5
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:855-737-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-88175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath