Provider Demographics
NPI:1932313871
Name:PACIFIC BAY NATUROPATHIC HEALTHCARE
Entity Type:Organization
Organization Name:PACIFIC BAY NATUROPATHIC HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:562-531-4220
Mailing Address - Street 1:PO BOX 83664
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90083-0664
Mailing Address - Country:US
Mailing Address - Phone:562-531-4220
Mailing Address - Fax:562-531-4220
Practice Address - Street 1:6218 MANCHESTER AVENUE
Practice Address - Street 2:SUITE D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045
Practice Address - Country:US
Practice Address - Phone:310-641-0111
Practice Address - Fax:610-641-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND106175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty