MEDICARE: WHOLE MEDICINE LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1932490968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE MEDICINE LLC

Provider Business Mailing Address
First Line	:	1595 38TH AVE
Second Line	:
City	:	CAPITOLA
State	:	CA
Zip	:	95010-2901
Country	:	US
Telephone Number	:	831-621-1848
Fax Number	:	831-621-1804

Provider Business Practice Location Address
First Line	:	1595 38TH AVE
Second Line	:
City	:	CAPITOLA
State	:	CA
Zip	:	95010-2901
Country	:	US
Telephone Number	:	831-621-1848
Fax Number	:	831-621-1804

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	BART TEEUWISSE
Credential	:
Telephone Number	:	831-621-1848

Provider Enumeration Date	:	04/25/2011
Last Update Date	:	09/07/2023

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