Provider Demographics
NPI:1487182143
Name:POWERS, THERESA (ND)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:POWERS
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 1:2222 SANTA MONICA BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2305
Mailing Address - Country:US
Mailing Address - Phone:310-828-8258
Mailing Address - Fax:310-828-5258
Practice Address - Street 1:2222 SANTA MONICA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2305
Practice Address - Country:US
Practice Address - Phone:310-828-8258
Practice Address - Fax:310-828-5258
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND897175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath