Healthcare Provider Details

I. General information

NPI: 1972118305
Provider Name (Legal Business Name): EDEN KIM PUDBERRY ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6078 OLD QUARRY LOOP
OAKLAND CA
94605-3380
US

IV. Provider business mailing address

6078 OLD QUARRY LOOP
OAKLAND CA
94605-3380
US

V. Phone/Fax

Practice location:
  • Phone: 415-726-7878
  • Fax:
Mailing address:
  • Phone: 415-726-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: