Provider Demographics
NPI:1942233838
Name:MEARS, LORETTA (ND)
Entity Type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:
Last Name:MEARS
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 1:3715 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1439
Mailing Address - Country:US
Mailing Address - Phone:510-473-6707
Mailing Address - Fax:
Practice Address - Street 1:3715 BROWN AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1439
Practice Address - Country:US
Practice Address - Phone:510-473-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3995111N00000X
NY3752-1133N00000X
175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111N00000XChiropractic ProvidersChiropractor
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT52643Medicare UPIN