Provider Demographics
NPI:1104568245
Name:PACIFIC INTEGRATIVE WELLNESS PC
Entity type:Organization
Organization Name:PACIFIC INTEGRATIVE WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:PATIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-231-6100
Mailing Address - Street 1:201 CLOUD VIEW TRL
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2071
Mailing Address - Country:US
Mailing Address - Phone:312-659-7700
Mailing Address - Fax:
Practice Address - Street 1:201 CLOUD VIEW TRL
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2071
Practice Address - Country:US
Practice Address - Phone:415-231-6100
Practice Address - Fax:415-231-6345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty