Provider Demographics
NPI:1710384375
Name:TONNU, MIMOSA TIEUTHU (ND)
Entity Type:Individual
Prefix:DR
First Name:MIMOSA
Middle Name:TIEUTHU
Last Name:TONNU
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 1:24 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2813
Mailing Address - Country:US
Mailing Address - Phone:626-419-4572
Mailing Address - Fax:
Practice Address - Street 1:359 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1345
Practice Address - Country:US
Practice Address - Phone:650-323-7345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath