Healthcare Provider Details

I. General information

NPI: 1063645869
Provider Name (Legal Business Name): NATUROPATHIC WISDOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S WINCHESTER BLVD STE E157
SAN JOSE CA
95128-3901
US

IV. Provider business mailing address

1101 S WINCHESTER BLVD STE E157
SAN JOSE CA
95128-3901
US

V. Phone/Fax

Practice location:
  • Phone: 408-297-6877
  • Fax: 404-829-6689
Mailing address:
  • Phone: 408-297-6877
  • Fax: 408-296-6894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-125
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID HOGG
Title or Position: OWNER
Credential: N.D.
Phone: 408-297-6877