Healthcare Provider Details

I. General information

NPI: 1750735965
Provider Name (Legal Business Name): NATHARCHIA R PEOPLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 CA-12
LODI CA
95240
US

IV. Provider business mailing address

9150 CA-12
LODI CA
95240
US

V. Phone/Fax

Practice location:
  • Phone: 209-642-2812
  • Fax:
Mailing address:
  • Phone: 209-642-2812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: