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General NPI Number Information
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NPI Number | 1972904183
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL CENTER FOR INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 09/07/2014
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Last Update Date | 09/07/2014
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Provider Practice Location Address
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Address Line | 3824 MACARTHUR BLVD
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City | OAKLAND
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State | CA
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Zip | 94619-1315
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Country | US
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Telephone | 510-336-0129
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Fax | 510-336-0297
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Provider Business Mailing Address
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Address Line | 3824 MACARTHUR BLVD
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City | OAKLAND
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State | CA
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Zip | 94619-1315
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Country | US
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Telephone | 510-336-0129
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Fax | 510-336-0297
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMY MATECKI
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Credential | MD
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Telephone | 510-336-0129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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