Healthcare Provider Details

I. General information

NPI: 1164235289
Provider Name (Legal Business Name): THE FACULTY PRACTICE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 RAMONA ST STE 2
PALO ALTO CA
94301-1724
US

IV. Provider business mailing address

PO BOX 1252
NEW YORK NY
10021-0038
US

V. Phone/Fax

Practice location:
  • Phone: 646-883-6640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIANA BRADLEY
Title or Position: INTAKE COORDINATOR
Credential:
Phone: 646-883-6640