Healthcare Provider Details

I. General information

NPI: 1083181838
Provider Name (Legal Business Name): SHYAMIA STONE ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6919 LA JOLLA BLVD
LA JOLLA CA
92037-5427
US

IV. Provider business mailing address

2510 TORREY PINES RD UNIT 306
LA JOLLA CA
92037-3435
US

V. Phone/Fax

Practice location:
  • Phone: 858-459-6919
  • Fax:
Mailing address:
  • Phone: 607-220-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: