Healthcare Provider Details

I. General information

NPI: 1073144762
Provider Name (Legal Business Name): INTEGRATED NEUROLOGY & PAIN MANAGEMENT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 GLEN COVE MARINA RD E STE 100
VALLEJO CA
94591-7284
US

IV. Provider business mailing address

712 BANCROFT ROAD STE 905
WALNUT CREEK CA
94598-1531
US

V. Phone/Fax

Practice location:
  • Phone: 707-980-6257
  • Fax: 707-980-6692
Mailing address:
  • Phone: 707-980-6257
  • Fax: 707-980-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMAR ANAND
Title or Position: CEO
Credential: MD
Phone: 707-980-6257