Provider Demographics
NPI:1215452693
Name:CHANDRANATA, INGGRID (ND)
Entity type:Individual
Prefix:
First Name:INGGRID
Middle Name:
Last Name:CHANDRANATA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E COLORADO BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3712
Mailing Address - Country:US
Mailing Address - Phone:626-766-8095
Mailing Address - Fax:
Practice Address - Street 1:12304 SANTA MONICA BLVD STE 370
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1542
Practice Address - Country:US
Practice Address - Phone:626-766-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND908175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath