Healthcare Provider Details

I. General information

NPI: 1316414105
Provider Name (Legal Business Name): SRUTI AMOS LAM ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 FIFTH AVE STE 300
SAN DIEGO CA
92103-4230
US

IV. Provider business mailing address

3636 FIFTH AVE STE 300
SAN DIEGO CA
92103-4230
US

V. Phone/Fax

Practice location:
  • Phone: 619-814-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: