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General NPI Number Information
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NPI Number | 1619407269
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE NATURAL MEDICINE
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Dates
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Enumeration Date | 06/15/2017
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Last Update Date | 06/15/2017
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Provider Practice Location Address
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Address Line | 2025 E CAMPBELL AVE #259
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City | PHOENIX
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State | AZ
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Zip | 85016-8501
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Country | US
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Telephone | 480-521-2775
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Fax | 480-521-2775
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Provider Business Mailing Address
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Address Line | 2025 E CAMPBELL AVE #259
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City | PHOENIX
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State | AZ
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Zip | 85016
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Country | US
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Telephone | 480-521-2775
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. CHRISTOPHER MICHAEL FUCCI
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Credential | DNM, PA
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Telephone | 480-521-2775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5659
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License Number State | AZ
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