Provider Demographics
NPI:1396783379
Name:ASANA INTEGRATED MEDICAL GROUP PC
Entity type:Organization
Organization Name:ASANA INTEGRATED MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-204-3500
Mailing Address - Street 1:PO BOX 411109
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-1109
Mailing Address - Country:US
Mailing Address - Phone:818-532-1297
Mailing Address - Fax:818-880-0430
Practice Address - Street 1:6200 CANOGA AVE STE 108
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-7793
Practice Address - Country:US
Practice Address - Phone:818-532-1297
Practice Address - Fax:818-880-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X, 363LP0808X, 2084P0800X
CAFNP296452084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA5859OtherRAILROAD MEDICARE GROUP I
CAW16659Medicare ID - Type UnspecifiedMEDICARE GROUP ID