Provider Demographics
NPI:1740439991
Name:POLISOTO, DEBORAH ANN (ND)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:POLISOTO
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 1:23371 MULHOLLAND DR
Mailing Address - Street 2:STE 148
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2734
Mailing Address - Country:US
Mailing Address - Phone:310-593-4527
Mailing Address - Fax:
Practice Address - Street 1:23371 MULHOLLAND DR
Practice Address - Street 2:STE 148
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2734
Practice Address - Country:US
Practice Address - Phone:310-593-4527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-289175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath