Healthcare Provider Details

I. General information

NPI: 1609216340
Provider Name (Legal Business Name): COASTSIDE INTEGRATIVE NATUROPATHIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 DONDEE ST SUITE 5
PACIFICA CA
94044-3056
US

IV. Provider business mailing address

450 DONDEE ST SUITE 5
PACIFICA CA
94044-3056
US

V. Phone/Fax

Practice location:
  • Phone: 650-380-0089
  • Fax:
Mailing address:
  • Phone: 650-380-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: SARAH ROTHMAN
Title or Position: PRESIDENT
Credential: ND, L.AC
Phone: 650-380-0089