Provider Demographics
NPI:1235801879
Name:HENDERSON CATALINA, GISELLE ALEXANDRA (ND)
Entity Type:Individual
Prefix:DR
First Name:GISELLE
Middle Name:ALEXANDRA
Last Name:HENDERSON CATALINA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5174 BELLVALE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4001
Mailing Address - Country:US
Mailing Address - Phone:857-300-0631
Mailing Address - Fax:
Practice Address - Street 1:1565 HOTEL CIR S STE 350
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3431
Practice Address - Country:US
Practice Address - Phone:619-356-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1272175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath