Healthcare Provider Details

I. General information

NPI: 1841706546
Provider Name (Legal Business Name): CASSIE RUTH NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 01/29/2024
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 GROSSMONT BLVD # 4-7
LA MESA CA
91941-4047
US

IV. Provider business mailing address

8898 NAVAJO RD STE C304
SAN DIEGO CA
92119-2141
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-9700
  • Fax: 619-486-8446
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: