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General NPI Number Information
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NPI Number | 1639856206
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Entity Type | Organization
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Legal Business Name | PACIFIC HEARTWOOD WELLNESS PC
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 1451 RIVER PARK DR STE 100
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City | SACRAMENTO
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State | CA
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Zip | 95815-4518
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Country | US
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Telephone | 916-292-9700
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Fax |
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Provider Business Mailing Address
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Address Line | 1451 RIVER PARK DR STE 100
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City | SACRAMENTO
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State | CA
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Zip | 95815-4518
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Country | US
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Telephone | 916-292-9700
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Fax |
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | LAUREN GORDON
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Credential |
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Telephone | 916-799-6259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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