Provider Demographics
NPI:1568735124
Name:REDDISH, CORY (ND)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:REDDISH
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 1:51 LORING AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3409
Mailing Address - Country:US
Mailing Address - Phone:415-383-3716
Mailing Address - Fax:415-367-2507
Practice Address - Street 1:51 LORING AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3409
Practice Address - Country:US
Practice Address - Phone:415-383-3716
Practice Address - Fax:415-367-2507
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-240175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath