Healthcare Provider Details

I. General information

NPI: 1336078351
Provider Name (Legal Business Name): FMI INTEGRATIVE BEHAVIORAL HEALTH & LONGEVITY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 W CENTURY BLVD FL 6
LOS ANGELES CA
90045-6401
US

IV. Provider business mailing address

27305 LIVE OAK RD STE A
CASTAIC CA
91384-4520
US

V. Phone/Fax

Practice location:
  • Phone: 310-908-0979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY G GALINDO
Title or Position: CEO
Credential:
Phone: 310-908-0979