Healthcare Provider Details

I. General information

NPI: 1720433808
Provider Name (Legal Business Name): AMALIYA AVETYAN SANTIAGO N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMALIYA AVETYAN SANTIAGO N.D.

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FAIR OAKS AVE STE 208
PASADENA CA
91105-2562
US

IV. Provider business mailing address

301 S FAIR OAKS AVE STE 208
PASADENA CA
91105-2562
US

V. Phone/Fax

Practice location:
  • Phone: 626-714-7400
  • Fax: 833-269-3526
Mailing address:
  • Phone: 626-714-7400
  • Fax: 833-269-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: