Provider Demographics
NPI:1750806352
Name:SHASTA INTEGRATIVE HEALTH
Entity type:Organization
Organization Name:SHASTA INTEGRATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PORZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:530-222-1777
Mailing Address - Street 1:85 HARTNELL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1888
Mailing Address - Country:US
Mailing Address - Phone:530-222-1777
Mailing Address - Fax:530-222-1879
Practice Address - Street 1:85 HARTNELL AVE STE 100
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1888
Practice Address - Country:US
Practice Address - Phone:530-222-1777
Practice Address - Fax:530-222-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1285654921208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty