Provider Demographics
NPI:1316626492
Name:RESILIENCE INTEGRATIVE
Entity type:Organization
Organization Name:RESILIENCE INTEGRATIVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-916-1211
Mailing Address - Street 1:6719 ALVARADO RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5257
Mailing Address - Country:US
Mailing Address - Phone:619-916-1211
Mailing Address - Fax:
Practice Address - Street 1:6719 ALVARADO RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5257
Practice Address - Country:US
Practice Address - Phone:619-916-1211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty