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General NPI Number Information
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NPI Number | 1871422790
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Entity Type | Organization
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Legal Business Name | ENTHEO CLINIC, A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/16/2026
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Last Update Date | 05/16/2026
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Provider Practice Location Address
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Address Line | 1700 EUREKA RD STE 155
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City | ROSEVILLE
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State | CA
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Zip | 95661-7786
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Country | US
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Telephone | 916-304-2214
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Fax | 916-938-2250
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Provider Business Mailing Address
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Address Line | 1700 EUREKA RD STE 155
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City | ROSEVILLE
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State | CA
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Zip | 95661-7786
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Country | US
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Telephone | 916-304-2214
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Fax | 916-938-2250
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Authorized Official
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Title or Position | FOUNDER
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Name | RIAN KABIR
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Credential | MD
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Telephone | 503-481-8796
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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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