Healthcare Provider Details

I. General information

NPI: 1831960913
Provider Name (Legal Business Name): KLEA DOKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7946 IVANHOE AVE STE 301
LA JOLLA CA
92037-4518
US

IV. Provider business mailing address

10791 CAMINITO ALVAREZ
SAN DIEGO CA
92126-5765
US

V. Phone/Fax

Practice location:
  • Phone: 858-263-0901
  • Fax:
Mailing address:
  • Phone: 586-646-6310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: