Provider Demographics
NPI:1700568078
Name:BODY AND MIND HEALTHCARE SERVICES - A NURSE CORPORATION
Entity Type:Organization
Organization Name:BODY AND MIND HEALTHCARE SERVICES - A NURSE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAMOTAR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:408-449-6623
Mailing Address - Street 1:1085 SANDERS AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-3935
Mailing Address - Country:US
Mailing Address - Phone:408-449-6623
Mailing Address - Fax:
Practice Address - Street 1:1085 SANDERS AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-3935
Practice Address - Country:US
Practice Address - Phone:408-449-6623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty