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Organization
MT DIABLO INTEGRATED WELLNESS INC
Active
Organization
MT DIABLO INTEGRATED WELLNESS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUPRABHA N JAIN M.D (OWNER)
(925) 935-5425
Entity
Organization
Contact information
Practice address
325 N WIGET LN, SUITE 130, WALNUT CREEK, CA 94598-2435
(925) 935-5425
(925) 947-2671
Mailing address
325 N WIGET LN, SUITE 130, WALNUT CREEK, CA 94598-2435
(925) 935-5425
(925) 947-2671
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A67699
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ05648Z
MEDICARE GROUP PTAN
CA
Enumeration date
08/06/2007
Last updated
02/23/2017
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