1497179519 NPI number — INTEGRATIVE AND HOLISTIC CENTER FOR HORMONE BALANCING, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497179519 NPI number — INTEGRATIVE AND HOLISTIC CENTER FOR HORMONE BALANCING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATIVE AND HOLISTIC CENTER FOR HORMONE BALANCING, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497179519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11956 BERNARDO PLAZA DRIVE
Provider Second Line Business Mailing Address:
141
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-521-0806
Provider Business Mailing Address Fax Number:
858-521-0808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2892 JEFFERSON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-434-9500
Provider Business Practice Location Address Fax Number:
619-260-0707
Provider Enumeration Date:
02/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MOEIN
Authorized Official First Name:
SUDABEH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ PHYSICIAN
Authorized Official Telephone Number:
310-465-9233

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A76561 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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