Provider Demographics
NPI:1841412046
Name:AMITABHA MEDICAL CLINIC & HEALING CENTER
Entity Type:Organization
Organization Name:AMITABHA MEDICAL CLINIC & HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:ELIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-829-5900
Mailing Address - Street 1:7064 CORLINE CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4528
Mailing Address - Country:US
Mailing Address - Phone:707-829-5900
Mailing Address - Fax:707-829-5282
Practice Address - Street 1:7064 CORLINE CT
Practice Address - Street 2:SUITE A
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4528
Practice Address - Country:US
Practice Address - Phone:707-829-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center