Provider Demographics
NPI:1467742015
Name:INTEGRATIVE PSYCHIATRY LLC
Entity Type:Organization
Organization Name:INTEGRATIVE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:LUIGI
Authorized Official - Middle Name:A
Authorized Official - Last Name:DULANTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-718-6419
Mailing Address - Street 1:30 RITO GUICU
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4301
Mailing Address - Country:US
Mailing Address - Phone:505-718-6419
Mailing Address - Fax:
Practice Address - Street 1:1925 ASPEN DR STE 901B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5569
Practice Address - Country:US
Practice Address - Phone:505-718-6419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-17
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0451261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health