Provider Demographics
NPI:1881249332
Name:CORNERSTONE INTEGRATIVE MEDICINE
Entity type:Organization
Organization Name:CORNERSTONE INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PARTNER, CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:SHORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-326-4649
Mailing Address - Street 1:3012 SUMMIT ST STE 2675
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3480
Mailing Address - Country:US
Mailing Address - Phone:510-326-4649
Mailing Address - Fax:
Practice Address - Street 1:3012 SUMMIT ST STE 2675
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3480
Practice Address - Country:US
Practice Address - Phone:510-869-6740
Practice Address - Fax:510-869-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346573094Medicaid
CA1790937506Medicaid
CA1932538121Medicaid
CA1831124080Medicaid
CA1861427684Medicaid
CA1770571077Medicaid
TN1245404607Medicaid
CA1558678201Medicaid
CA1003114463Medicaid
CA1295995256Medicaid