Healthcare Provider Details

I. General information

NPI: 1043867005
Provider Name (Legal Business Name): LISA FORTES-SCHRAMM ND, DTCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 ROSS AVE STE 101
SAN JOSE CA
95124-3038
US

IV. Provider business mailing address

16812 SE POWELL BLVD APT 203
PORTLAND OR
97236-8705
US

V. Phone/Fax

Practice location:
  • Phone: 831-783-5983
  • Fax: 844-740-0003
Mailing address:
  • Phone: 318-783-5983
  • Fax: 844-740-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: