Pacific Integrative Wellness PC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

PACIFIC INTEGRATIVE WELLNESS PC

Practice address

201 Cloud View TRL
Sausalito, CA 94965-2071

Phone

(415) 231-6100

Fax

(415) 231-6345

NPI assigned

Apr 9, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sandeep Patil

Title

Coo

Phone

(415) 231-6100

Specialties & licenses 4

Addresses

Other names 2

• Pacific Integrative Psychiatry Doing business as
• IntraBalance PC Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649462400000",
    "number": "1104568245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 CLOUD VIEW TRL",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "949652071",
            "telephone_number": "312-659-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 CLOUD VIEW TRL",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "949652071",
            "telephone_number": "415-231-6100",
            "fax_number": "415-231-6345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC INTEGRATIVE WELLNESS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-09",
        "last_updated": "2022-04-09",
        "certification_date": "2022-04-09",
        "status": "A",
        "authorized_official_last_name": "PATIL",
        "authorized_official_first_name": "SANDEEP",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "415-231-6100"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Integrative Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "IntraBalance PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Carolyn Petersen, M.D.

• Psychiatry Physician in Sausalito, CA
• Providers in Sausalito, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.