Provider Demographics
NPI:1609928878
Name:THOMPSON, DARA FAITH (ND)
Entity Type:Individual
Prefix:DR
First Name:DARA
Middle Name:FAITH
Last Name:THOMPSON
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 1:1005 NORTHGATE DR # 154
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2500
Mailing Address - Country:US
Mailing Address - Phone:415-755-5435
Mailing Address - Fax:866-612-0368
Practice Address - Street 1:1330 LINCOLN AVE STE 304
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2143
Practice Address - Country:US
Practice Address - Phone:415-755-5435
Practice Address - Fax:866-612-0368
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-67175F00000X
MTAHC-NAT-LIC-2415175F00000X
HIND-147175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath