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General NPI Number Information
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NPI Number | 1205462389
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Entity Type | Organization
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Legal Business Name | CALIFORNIA INTEGRATIVE MEDICINE, INC.
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 1850 TICE VALLEY BOULEVARD
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City | WALNUT CREEK
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State | CA
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Zip | 94595-2224
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Country | US
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Telephone | 925-310-7836
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Fax | 925-405-0965
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Provider Business Mailing Address
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Address Line | 1850 TICE VALLEY BOULEVARD
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City | WALNUT CREEK
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State | CA
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Zip | 94595-2224
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Country | US
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Telephone | 925-310-7836
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Fax | 925-405-0965
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Authorized Official
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Title or Position | VICE PRESIDENT/SECRETARY
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Name | BRIAN THOMASON
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Credential |
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Telephone | 925-222-0491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics 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 | 208D00000X
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Taxonomy Name | General Practice 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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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