Healthcare Provider Details

I. General information

NPI: 1215452693
Provider Name (Legal Business Name): INGGRID CHANDRANATA ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12304 SANTA MONICA BLVD STE 370
LOS ANGELES CA
90025-1542
US

IV. Provider business mailing address

117 E COLORADO BLVD STE 600
PASADENA CA
91105-3712
US

V. Phone/Fax

Practice location:
  • Phone: 626-766-8095
  • Fax:
Mailing address:
  • Phone: 626-766-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: