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General NPI Number Information
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NPI Number | 1336719178
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Entity Type | Organization
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Legal Business Name | HOLISTIC INTEGRATIVE PSYCHIATRY CORP
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Dates
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Enumeration Date | 06/24/2021
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 1980 KETTNER BLVD APT 237
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City | SAN DIEGO
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State | CA
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Zip | 92101-2256
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Country | US
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Telephone | 303-444-6800
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Fax | 303-496-6802
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Provider Business Mailing Address
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Address Line | PO BOX 21150
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City | BOULDER
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State | CO
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Zip | 80308-4150
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Country | US
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Telephone | 619-548-7474
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Fax | 303-496-6802
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Authorized Official
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Title or Position | OWNER
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Name | DONNA MARIE GRANDI-NIKANDER
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Credential | MSN, FNP
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Telephone | 303-444-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family 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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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