Healthcare Provider Details

I. General information

NPI: 1568735124
Provider Name (Legal Business Name): CORY REDDISH ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 LORING AVE
MILL VALLEY CA
94941-3409
US

IV. Provider business mailing address

51 LORING AVE
MILL VALLEY CA
94941-3409
US

V. Phone/Fax

Practice location:
  • Phone: 415-383-3716
  • Fax: 415-367-2507
Mailing address:
  • Phone: 415-383-3716
  • Fax: 415-367-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: