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General NPI Number Information
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NPI Number | 1962683755
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Entity Type | Organization
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Legal Business Name | INTEGRAL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 07/28/2011
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Provider Practice Location Address
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Address Line | 4225 EXECUTIVE SQ STE 355
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City | LA JOLLA
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State | CA
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Zip | 92037-1483
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Country | US
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Telephone | 858-729-0305
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Fax | 858-729-0232
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Provider Business Mailing Address
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Address Line | 4225 EXECUTIVE SQ STE 355
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City | LA JOLLA
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State | CA
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Zip | 92037-1483
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Country | US
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Telephone | 858-729-0305
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Fax | 858-729-0232
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ZHANNA VERKH
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Credential | M.D.
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Telephone | 858-729-0305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | A061830
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License Number State | CA
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