| Organization Name: | INTEGRATIVE MEDICAL CLINIC OF SANTA ROSA, A PROFESSIONAL CORPORATION |
| NPI Number: | 1750435624 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT DOZOR (OWNER) |
| Mailing Address: | 175 Concourse Blvd Santa Rosa |
| State: | CA US |
| Postal Code: | 954038217 |
| Phone Number: | 7072849200 |
| Fax Number: | 7072849204 |
| NPI Enumeration Date: | 01/22/2007 |
| NPI Last Update Date: | 12/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |