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General NPI Number Information
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NPI Number | 1871866483
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Entity Type | Organization
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Legal Business Name | ELITE INTEGRATIVE MEDICINE & WELLNESS CENTER, INC
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 26335 CARMEL RANCHO BLVD SUITE 1
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City | CARMEL
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State | CA
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Zip | 93923-8876
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Country | US
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Telephone | 831-625-6000
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Fax | 831-625-6001
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Provider Business Mailing Address
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Address Line | 26335 CARMEL RANCHO BLVD SUITE 1
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City | CARMEL
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State | CA
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Zip | 93923-8876
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Country | US
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Telephone | 831-625-6000
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Fax | 831-625-6001
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHERYL DENISE BRYANTBRUCE
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Credential | MD
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Telephone | 831-625-6000
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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 | CA
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