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General NPI Number Information
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NPI Number | 1164235289
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Entity Type | Organization
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Legal Business Name | THE FACULTY PRACTICE, P.C.
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 535 RAMONA ST STE 2
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City | PALO ALTO
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State | CA
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Zip | 94301-1724
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Country | US
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Telephone | 646-883-6640
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1252
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City | NEW YORK
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State | NY
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Zip | 10021-0038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INTAKE COORDINATOR
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Name | JULIANA BRADLEY
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Credential |
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Telephone | 646-883-6640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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