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General NPI Number Information
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NPI Number | 1144044629
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Entity Type | Organization
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Legal Business Name | ROAMING NATUROPATH
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 3535 ROSS AVE STE 101
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City | SAN JOSE
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State | CA
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Zip | 95124-3038
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Country | US
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Telephone | 408-357-3422
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Fax |
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Provider Business Mailing Address
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Address Line | 16812 SE POWELL BLVD APT 203
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City | PORTLAND
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State | OR
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Zip | 97236-8705
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Country | US
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Telephone | 916-803-7790
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Fax |
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Authorized Official
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Title or Position | DOCTOR, OWNER
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Name | DR. LISA FORTES-SCHRAMM
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Credential | ND, DTCM
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Telephone | 916-803-7790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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