Healthcare Provider Details

I. General information

NPI: 1689991572
Provider Name (Legal Business Name): CENTER FOR INTEGRAL HEALING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 FARMERS LANE #203
SANTA ROSA CA
95405
US

IV. Provider business mailing address

182 FARMERS LANE #203
SANTA ROSA CA
95405
US

V. Phone/Fax

Practice location:
  • Phone: 707-578-0961
  • Fax: 707-578-0961
Mailing address:
  • Phone: 707-578-0961
  • Fax: 707-578-0961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT17723
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberPT17723
License Number StateCA

VIII. Authorized Official

Name: MS. RENEE G. VALENTINO
Title or Position: PRESIDENT
Credential: P.T.
Phone: 707-578-0961