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General NPI Number Information
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NPI Number | 1558716977
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Entity Type | Organization
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Legal Business Name | KILTAYA NATURAL MEDICINE, INC.
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 0 PROFILE CIR
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City | NASHUA
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State | NH
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Zip | 03063-1716
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Country | US
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Telephone | 978-226-3787
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Fax | 480-582-0441
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Provider Business Mailing Address
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Address Line | 379 AMHERST ST. PMB 130
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City | NASHUA
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State | NH
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Zip | 03063
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Country | US
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Telephone | 978-226-3787
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Fax | 480-582-0441
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DAVID ANTAYA
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Credential |
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Telephone | 978-226-3787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 132
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License Number State | NH
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