Healthcare Provider Details

I. General information

NPI: 1356756910
Provider Name (Legal Business Name): PACIFIC INTEGRATIVE MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 RHODE ISLAND ST SUITE 201
SAN FRANCISCO CA
94103-5177
US

IV. Provider business mailing address

383 RHODE ISLAND ST SUITE 201
SAN FRANCISCO CA
94103-5177
US

V. Phone/Fax

Practice location:
  • Phone: 415-935-4249
  • Fax:
Mailing address:
  • Phone: 415-935-4249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. HARRY MCILROY
Title or Position: PRESIDENT
Credential: MD
Phone: 415-952-0290