Provider Demographics
NPI:1205462389
Name:CALIFORNIA INTEGRATIVE MEDICINE, INC.
Entity type:Organization
Organization Name:CALIFORNIA INTEGRATIVE MEDICINE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-222-0491
Mailing Address - Street 1:1850 TICE VALLEY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-2224
Mailing Address - Country:US
Mailing Address - Phone:925-310-7836
Mailing Address - Fax:925-405-0965
Practice Address - Street 1:1850 TICE VALLEY BOULEVARD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-2224
Practice Address - Country:US
Practice Address - Phone:925-310-7836
Practice Address - Fax:925-405-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2021-04-14
Deactivation Date:2021-02-09
Deactivation Code:
Reactivation Date:2021-03-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty