Provider Demographics
NPI:1205220837
Name:NATURALSTART NATUROPATHIC FAMILY MEDICINE, INC.
Entity Type:Organization
Organization Name:NATURALSTART NATUROPATHIC FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NATUROPATHIC DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE ANGELA
Authorized Official - Middle Name:DELA ROSA
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:650-964-6700
Mailing Address - Street 1:5050 EL CAMINO REAL
Mailing Address - Street 2:STE 110
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1530
Mailing Address - Country:US
Mailing Address - Phone:650-964-6700
Mailing Address - Fax:650-964-3495
Practice Address - Street 1:5050 EL CAMINO REAL
Practice Address - Street 2:STE 110
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1530
Practice Address - Country:US
Practice Address - Phone:650-964-6700
Practice Address - Fax:650-964-3495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND656175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty