Provider Demographics
NPI:1982151676
Name:LIGHTHEARTED MEDICINE, INC.
Entity Type:Organization
Organization Name:LIGHTHEARTED MEDICINE, INC.
Other - Org Name:LIGHTHEARTED MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-964-0546
Mailing Address - Street 1:1700 MONTGOMERY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-1022
Mailing Address - Country:US
Mailing Address - Phone:415-964-0546
Mailing Address - Fax:888-861-2143
Practice Address - Street 1:1700 MONTGOMERY ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-1022
Practice Address - Country:US
Practice Address - Phone:415-964-0546
Practice Address - Fax:888-861-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53920261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service