Provider Demographics
NPI:1649581521
Name:EASTSIDE INTEGRATIVE HEALTH
Entity Type:Organization
Organization Name:EASTSIDE INTEGRATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITOV
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:425-457-7799
Mailing Address - Street 1:1370 116TH AVE NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3825
Mailing Address - Country:US
Mailing Address - Phone:425-457-7799
Mailing Address - Fax:425-614-0678
Practice Address - Street 1:3831 145TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1569
Practice Address - Country:US
Practice Address - Phone:425-457-7799
Practice Address - Fax:425-614-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000668175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty