Provider Demographics
NPI:1932369105
Name:BRISTOL, AMY J (ND)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:BRISTOL
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 1:2420 BORTON DR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93109-1838
Mailing Address - Country:US
Mailing Address - Phone:805-705-5804
Mailing Address - Fax:
Practice Address - Street 1:2420 BORTON DR
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93109-1838
Practice Address - Country:US
Practice Address - Phone:805-705-5804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-29175F00000X
WANT00000994175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath