Provider Demographics
NPI:1881021848
Name:INTEGRATED HEALTH CENTER OF ROSEVILLE PC
Entity Type:Organization
Organization Name:INTEGRATED HEALTH CENTER OF ROSEVILLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-550-1750
Mailing Address - Street 1:1411 SECRET RAVINE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-6041
Mailing Address - Country:US
Mailing Address - Phone:916-786-2002
Mailing Address - Fax:916-786-2003
Practice Address - Street 1:1411 SECRET RAVINE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6041
Practice Address - Country:US
Practice Address - Phone:916-786-2002
Practice Address - Fax:916-786-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ81379YOtherBCBS
CAZZZ81379YOtherBCBS