Provider Demographics
NPI:1316708571
Name:LYTLE-PINHEY, NATHAN (AYURVEDIC PRACTIONER)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:LYTLE-PINHEY
Suffix:
Gender:M
Credentials:AYURVEDIC PRACTIONER
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:
Other - Last Name:LYTLEPINHEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLE RECOVERY MANAGER
Mailing Address - Street 1:2904 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-3318
Mailing Address - Country:US
Mailing Address - Phone:209-241-1932
Mailing Address - Fax:
Practice Address - Street 1:2904 5TH ST
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-3318
Practice Address - Country:US
Practice Address - Phone:209-241-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner