Organization
NUTRITION BASED INTEGRATIVE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE DANIEL D.O. (OWNER)
(916) 564-3300
Entity
Organization
Contact information
Practice address
758 UNIVERSITY AVE, SACRAMENTO, CA 95825-6703
(916) 564-3300
(916) 927-1831
Mailing address
9115 YELLOW FLOWER PL, FAIR OAKS, CA 95628-6563
(916) 564-3300
(916) 927-1831
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
20A10508
CA
207QS0010X
Sports Medicine (Family Medicine) Physician
20A10508
CA
Other
Enumeration date
07/31/2012
Last updated
07/31/2012
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