Provider Demographics
NPI:1447478987
Name:CIST, DOROTHEA (ND)
Entity type:Individual
Prefix:DR
First Name:DOROTHEA
Middle Name:
Last Name:CIST
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 1:33533 VISTA COLINA
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1642
Mailing Address - Country:US
Mailing Address - Phone:949-429-7118
Mailing Address - Fax:949-419-7132
Practice Address - Street 1:33533 VISTA COLINA
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-1642
Practice Address - Country:US
Practice Address - Phone:949-429-7118
Practice Address - Fax:949-419-7132
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-135175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
MC-1357878OtherDEA NUMBER