Healthcare Provider Details

I. General information

NPI: 1316068299
Provider Name (Legal Business Name): KANNAMMA KANNAN NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 MIRAMAR RD SUITE 210
SAN DIEGO CA
92126-4560
US

IV. Provider business mailing address

10323 RESERVE DR # 106
SAN DIEGO CA
92127-3566
US

V. Phone/Fax

Practice location:
  • Phone: 858-205-5152
  • Fax: 866-351-7419
Mailing address:
  • Phone: 858-312-5721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: