Provider Demographics
NPI:1336511450
Name:OSTROOT, CORY WILLIAM (ND)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:WILLIAM
Last Name:OSTROOT
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 SORRENTO VALLEY RD STE 225
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1601
Mailing Address - Country:US
Mailing Address - Phone:619-345-3111
Mailing Address - Fax:844-685-9511
Practice Address - Street 1:10505 SORRENTO VALLEY RD STE 225
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:619-345-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND966175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath