Provider Demographics
NPI:1396973426
Name:AVEDA INTEGRATIVE MEDICAL CENTER INC
Entity type:Organization
Organization Name:AVEDA INTEGRATIVE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-229-9738
Mailing Address - Street 1:43628 SKYE RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5925
Mailing Address - Country:US
Mailing Address - Phone:510-790-2144
Mailing Address - Fax:510-266-1515
Practice Address - Street 1:4077 PERALTA BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4849
Practice Address - Country:US
Practice Address - Phone:510-790-2144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty