1912737198 NPI number — BLOOM & BUILD, CENTER FOR REPRODUCTIVE & INTEGRATIVE PSYCHIATRY, INC.

Table of content: DR. ALICIA ARLYNE MITCHELL D.C. (NPI 1497840169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912737198 NPI number — BLOOM & BUILD, CENTER FOR REPRODUCTIVE & INTEGRATIVE PSYCHIATRY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLOOM & BUILD, CENTER FOR REPRODUCTIVE & INTEGRATIVE PSYCHIATRY, 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:
1912737198
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 E HAMILTON AVE # 1020
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMPBELL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95008-0210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-549-4392
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1760 THE ALAMEDA STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95126-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-800-1363
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2024

Additional Information

Authorized Official

Authorized Official Last Name:
GREENLEE
Authorized Official First Name:
ALECIA
Authorized Official Middle Name:
LANETTE
Authorized Official Title or Position:
FOUNDER AND CEO
Authorized Official Telephone Number:
408-800-1519

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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