Organization
INNERBLOOM KETAMINE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAY RIVAS MD (MD)
(805) 321-8471
Entity
Organization
Contact information
Practice address
100 CASA ST STE D3, SAN LUIS OBISPO, CA 93405-5827
(805) 321-8471
(805) 567-6604
Mailing address
100 CASA ST STE D3, SAN LUIS OBISPO, CA 93405-5827
(805) 321-8471
(805) 567-6604
Taxonomy
Speciality
Code
Description
License number
State
202D00000X
Integrative Medicine Physician
Primary
—
—
Other
Enumeration date
12/09/2024
Last updated
03/03/2026
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