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General NPI Number Information
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NPI Number | 1891587879
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Entity Type | Organization
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Legal Business Name | HEALTH INSIGHT KETAMINE CLINIC
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 40926 FREMONT BLVD
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City | FREMONT
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State | CA
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Zip | 94538-4375
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Country | US
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Telephone | 816-772-4383
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Fax |
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Provider Business Mailing Address
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Address Line | 40926 FREMONT BLVD
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City | FREMONT
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State | CA
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Zip | 94538-4375
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Country | US
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Telephone | 510-256-7874
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Fax | 510-256-7884
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Authorized Official
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Title or Position | CEO
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Name | KERRIE HUMBATOVA
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Credential | NP
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Telephone | 816-772-4383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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