Provider Demographics
NPI:1497162192
Name:KOVACICH, JEFFERY (ND)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:
Last Name:KOVACICH
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 1:10399 LEMON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3770
Mailing Address - Country:US
Mailing Address - Phone:909-989-1911
Mailing Address - Fax:
Practice Address - Street 1:10399 LEMON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3770
Practice Address - Country:US
Practice Address - Phone:909-989-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND660175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath