=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235801879
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GISELLE ALEXANDRA HENDERSON CATALINA ND
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2021
-----------------------------------------------------
Last Update Date | 10/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1565 HOTEL CIR S STE 350
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-3431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-356-0498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5174 BELLVALE AVE
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92117-4001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-300-0631
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | ND1272
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------