Healthcare Provider Details

I. General information

NPI: 1679922025
Provider Name (Legal Business Name): INTEGRATIVE PRACTITIONERS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 AMBER VALLEY DR
WHITTIER CA
90604-4051
US

IV. Provider business mailing address

16200 AMBER VALLEY DR
WHITTIER CA
90604-4051
US

V. Phone/Fax

Practice location:
  • Phone: 562-445-4063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ANDRE GALLARDO
Title or Position: CONTACT
Credential: PA
Phone: 562-943-7125