Provider Demographics
NPI:1689991903
Name:BRANSON, PEGGY DELONG (ND)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:DELONG
Last Name:BRANSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:DELONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:1831 ORANGE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2839
Mailing Address - Country:US
Mailing Address - Phone:949-743-5770
Mailing Address - Fax:949-574-9854
Practice Address - Street 1:1831 ORANGE AVE STE A
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2839
Practice Address - Country:US
Practice Address - Phone:949-743-5770
Practice Address - Fax:949-574-9854
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10-1186175F00000X
CAND644175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath