# RIVER STREET INTEGRATIVE MEDICINE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417293267
- **Authorized official:** DR. LESTER JAY BRODIE M.D. (MEDICAL DOCTOR)
- **Authorized official phone:** (831) 457-2000

## Contact information

- **Practice address:** 700 RIVER ST, SANTA CRUZ, CA 95060-2748
- **Practice address phone:** (831) 457-2000
- **Practice address fax:** (831) 457-2140
- **Mailing address:** 700 RIVER ST, SANTA CRUZ, CA 95060-2748
- **Mailing address phone:** (831) 457-2000
- **Mailing address fax:** (831) 457-2140

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A79910 | CA | Yes |

## Other

- **Enumeration date:** 12/26/2012
- **Last updated:** 06/13/2013