Provider Demographics
NPI:1881894483
Name:MINDFUL HEALTH SOLUTIONS A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:MINDFUL HEALTH SOLUTIONS A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOBIAS
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MARTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-988-4863
Mailing Address - Street 1:1020 SUNCAST LN
Mailing Address - Street 2:SUITE 108
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9335
Mailing Address - Country:US
Mailing Address - Phone:916-932-0380
Mailing Address - Fax:916-932-0381
Practice Address - Street 1:360 POST ST STE 500
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4908
Practice Address - Country:US
Practice Address - Phone:844-867-8444
Practice Address - Fax:415-964-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
CAA853022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA164036OtherMEDICARE PTAN
CACA164036OtherMEDICARE PTAN