Provider Demographics
NPI:1053584680
Name:MADERIS, TODD A (ND)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:MADERIS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LARKSPUR LANDING CIR STE 205
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1711
Mailing Address - Country:US
Mailing Address - Phone:415-945-3213
Mailing Address - Fax:415-329-5080
Practice Address - Street 1:700 LARKSPUR LANDING CIR STE 205
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1711
Practice Address - Country:US
Practice Address - Phone:415-945-3213
Practice Address - Fax:415-329-5080
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND279175F00000X
CA12850171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Yes175F00000XOther Service ProvidersNaturopath