MEDICARE: DR. PEGGY DELONG BRANSON N.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	10-1186	AZ
2	175F00000X	Naturopath	ND644	CA

General Provider Information

NPI Number	:	1689991903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEGGY DELONG BRANSON N.D.

Provider Business Mailing Address
First Line	:	1831 ORANGE AVE STE A
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-2839
Country	:	US
Telephone Number	:	949-743-5770
Fax Number	:	949-574-9854

Provider Business Practice Location Address
First Line	:	1831 ORANGE AVE STE A
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-2839
Country	:	US
Telephone Number	:	949-743-5770
Fax Number	:	949-574-9854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	03/03/2017

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