Healthcare Provider Details

I. General information

NPI: 1841925112
Provider Name (Legal Business Name): JEANETTE ALBA ND OR NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/20/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 CONVOY ST
SAN DIEGO CA
92111-3737
US

IV. Provider business mailing address

4344 CONVOY ST
SAN DIEGO CA
92111-3737
US

V. Phone/Fax

Practice location:
  • Phone: 909-728-0576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberND1325
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: