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General NPI Number Information
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NPI Number | 1992131577
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Entity Type | Organization
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Legal Business Name | KIVA SPIRIT FOUNDATION
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 2222 2ND ST SUITE 12
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City | LIVERMORE
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State | CA
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Zip | 94550-4554
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Country | US
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Telephone | 925-485-9370
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1424
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City | PLEASANTON
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State | CA
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Zip | 94566-0142
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Country | US
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Telephone | 925-485-9370
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. MATT GOMES
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Credential | PHD, LMFT
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Telephone | 925-485-9370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State | CA
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