Healthcare Provider Details

I. General information

NPI: 1205462389
Provider Name (Legal Business Name): CALIFORNIA INTEGRATIVE MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date: 02/09/2021
Reactivation Date: 03/19/2021

III. Provider practice location address

1850 TICE VALLEY BOULEVARD
WALNUT CREEK CA
94595-2224
US

IV. Provider business mailing address

1850 TICE VALLEY BOULEVARD
WALNUT CREEK CA
94595-2224
US

V. Phone/Fax

Practice location:
  • Phone: 925-310-7836
  • Fax: 925-405-0965
Mailing address:
  • Phone: 925-310-7836
  • Fax: 925-405-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN THOMASON
Title or Position: VICE PRESIDENT/SECRETARY
Credential:
Phone: 925-222-0491