Provider Demographics
NPI:1598926792
Name:MOCK, TRISTIN (ND)
Entity Type:Individual
Prefix:DR
First Name:TRISTIN
Middle Name:
Last Name:MOCK
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 1:1405 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2539
Mailing Address - Country:US
Mailing Address - Phone:541-963-7435
Mailing Address - Fax:541-963-7435
Practice Address - Street 1:1405 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2539
Practice Address - Country:US
Practice Address - Phone:541-963-7435
Practice Address - Fax:541-963-7435
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2023-01-27
Deactivation Date:2011-03-29
Deactivation Code:
Reactivation Date:2023-01-27
Provider Licenses
StateLicense IDTaxonomies
OR1613175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath