Provider Demographics
NPI:1295914182
Name:COOLURIS, DENISE MARIE (ND)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:MARIE
Last Name:COOLURIS
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 1:6028 FREDRICKS RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-5643
Mailing Address - Country:US
Mailing Address - Phone:360-470-9911
Mailing Address - Fax:
Practice Address - Street 1:435 PETALUMA AVE STE 150
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4273
Practice Address - Country:US
Practice Address - Phone:707-861-7300
Practice Address - Fax:707-823-8568
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA353175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath