Healthcare Provider Details

I. General information

NPI: 1083058119
Provider Name (Legal Business Name): NATALIE JUNE LUNDGREN OTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 DIVISADERO ST STE 300
SAN FRANCISCO CA
94117-2242
US

IV. Provider business mailing address

515 W 110TH ST APT 1A
NEW YORK NY
10025-2046
US

V. Phone/Fax

Practice location:
  • Phone: 415-551-0975
  • Fax:
Mailing address:
  • Phone: 415-810-2372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: