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General NPI Number Information
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NPI Number | 1902280712
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Entity Type | Organization
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Legal Business Name | SAN JOSE INTEGRATIVE WELLNESS CENTER INC
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Dates
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Enumeration Date | 07/13/2015
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 825 POLLARD RD STE 108
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City | LOS GATOS
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State | CA
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Zip | 95032-1435
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Country | US
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Telephone | 408-357-0105
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Fax | 408-357-0105
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Provider Business Mailing Address
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Address Line | 825 POLLARD RD STE 108
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City | LOS GATOS
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State | CA
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Zip | 95032-1435
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Country | US
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Telephone | 408-357-0105
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Fax | 408-357-0105
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Authorized Official
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Title or Position | OWNER
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Name | MANUJ KUMAR NANGIA
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Credential | MD
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Telephone | 408-357-0105
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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 | A91711
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License Number State | CA
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