MEDICARE: MINDFUL HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A72944	CA

General Provider Information

NPI Number	:	1538328554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL HEALTH INC

Provider Business Mailing Address
First Line	:	2000 BROADWAY ST
Second Line	:	STE 234
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1843
Country	:	US
Telephone Number	:	650-363-7234
Fax Number	:	650-363-7279

Provider Business Practice Location Address
First Line	:	2000 BROADWAY ST
Second Line	:	STE 234
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1843
Country	:	US
Telephone Number	:	650-363-7234
Fax Number	:	650-363-7279

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM MAXWELL BURNS
Credential	:	MD
Telephone Number	:	650-363-7234

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/05/2008

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