Healthcare Provider Details

I. General information

NPI: 1043653074
Provider Name (Legal Business Name): SANGITAPRIYA PEDRO N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 09/15/2024
Certification Date: 09/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 REDWOOD HWY FRONTAGE RD
MILL VALLEY CA
94941-3034
US

IV. Provider business mailing address

3439 NE SANDY BLVD # 359
PORTLAND OR
97232-1959
US

V. Phone/Fax

Practice location:
  • Phone: 415-569-4470
  • Fax: 844-787-4719
Mailing address:
  • Phone: 207-274-2111
  • Fax: 207-221-1095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1426
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: