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General NPI Number Information
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NPI Number | 1932321387
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Entity Type | Organization
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Legal Business Name | INSTITUTE FOR HEALTH MANAGEMENT INC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 715 SOUTHPOINT BLVD SUITE C
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City | PETALUMA
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State | CA
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Zip | 94954-6835
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Country | US
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Telephone | 707-778-6019
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Fax | 707-778-6068
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Provider Business Mailing Address
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Address Line | 715 SOUTHPOINT BLVD SUITE C
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City | PETALUMA
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State | CA
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Zip | 94954-6835
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Country | US
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Telephone | 707-778-6019
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Fax | 707-778-6068
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ROBERT PARK
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Credential | MD
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Telephone | 707-778-6019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | G022984
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License Number State | CA
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