Organization
INTEGRATED MIND INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WARRIS RICHARD WALAYAT SR. M.D. (CHAIRMAN)
(909) 796-4774
Entity
Organization
Contact information
Practice address
24949 PROSPECT AVE, LOMA LINDA, CA 92354-2811
(909) 796-4774
(909) 796-2774
Mailing address
24550 LAWTON AVE, LOMA LINDA, CA 92354-3336
(909) 796-4774
(909) 796-2774
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
A97080
CA
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
A97080
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A970800
—
CA
Enumeration date
06/03/2009
Last updated
03/12/2012
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