Provider Demographics
NPI:1396212205
Name:NG, GAREK RAYMOND (ND)
Entity Type:Individual
Prefix:
First Name:GAREK
Middle Name:RAYMOND
Last Name:NG
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 1:4130 LA JOLLA VILLAGE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1480
Mailing Address - Country:US
Mailing Address - Phone:858-964-0441
Mailing Address - Fax:
Practice Address - Street 1:4130 LA JOLLA VILLAGE DR STE 201
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1480
Practice Address - Country:US
Practice Address - Phone:858-964-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1035175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath